Outdoor Outreach Summer Adventures 2020: Tuition Assistance Questionnaire
Basic Information
Parent/Guardian First Name:
Parent/Guardian Last Name:
Parent/Guardian Email:
Parent/Guardian Phone Number:
Participant's Last Name:
Participant's First Name:
Participant's Age:
Summer Adventures Session Dates:
Please select...
Junior Adventures: July 6 - 10, 2020 (Ages 11-13)
Junior Adventures: July 20 - 24, 2020 (Ages 11-13)
Teen Leadership Adventures: August 3 - 7, 2020 (Ages 14-17)
Adventure Extension: August 10 - 14 (Ages 11 - 15) Additional week of Programs for Summer 2020
Address Line 1
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Postal Code
Household Information
Our family resides in one of the following six zip codes:
9
2102, 92105, 92113, 92114, 92115, 92139
Yes
No
Our family qualifies for free or reduced lunch.
Yes
No
My child(ren) has/have participated in an Outdoor Outreach program before.
Yes
No
Our family household size is:
Please select...
1
2
3
4
5
6
7
8 or more
Our family's Annual Gross Income is:
Military Status
Did one or more Parent(s)/Guardian(s) serve in the US Military?
Please select...
Yes
No
Status
Please select...
Active Duty
Reserve
Retired
Veteran
Branch of Service
Please select...
Air Force
Air National Guard
Army
Army National Guard
Coast Guard
Marines
Navy
I am willing and able to pay the following amount for this program:
$350
$300
$250
$200
$150
$100
$50
We can not participate without full tuition assistance
Please provide a brief statement of need (200 character limit).
Signature
Please provide your name confirming that the information you provided above is true.
Please initial to confirm your agreement to pay at minimum a tuition assistance fee of $20.00 for each child registered. This fee is non-refundable.
Contact Information