We’re glad that you’re taking the time to fill out this campership application. If you'd rather print and fill out this form, you can download a copy here. We believe every child and family should have the opportunity to experience the adventures of summer camp at Camp Lutherhaven regardless of financial situation. We've tried to make it easy to fill out, but if you have any questions, please contact us at firstname.lastname@example.org or (260) 636-7101.
Eligibility is based on your income and the number of people in your household. Please fill out the information below and return it as soon as possible. Gifts will be given out on a first come, first serve basis as funds are available.
Please note that this form is secure and that the information you provide will be treated confidentially and will be used only for determining eligibility. Your prompt and completed application gives you the best chance of receiving financial assistance. You will receive a campership acceptance or denial email within 7 days of submitting it. If you have not yet registered, you will have 14 days to register your child(ren) at which point your campership award will be made available to others needing assistance. If your campership request is denied, you will have the choice for your deposit to be returned or continue with the registration process.
Please include all campers for whom you desire financial aid. Add/remove campers by clicking the the +/- icons to the right of a row (bottom on mobile).
Household Names & Income
Household names: Please write the names of EVERYONE living in your house regardless of earning income or not. Include yourself, spouse, children, grandparents, other relatives, and any other unrelated people living in your house.
Income: Include the amount of gross income (if any) that each household member receivedlast month, before taxes or anything else is taken out. Write it in the appropriate income column based on where it came from. If any amount last month was more or less than usual, write that person’s usual monthly income. To determine monthly income, use the following table: If you receive income…
|Weekly||Enter weekly amount X 4.33|
|Twice Per Month||Enter twice a month X 2|
|Every 2 Weeks||Enter every 2 weeks X 2.15|
|Annualy||Enter annually ÷ 12|
Type 1 (Earnings…)
- Strike benefits
- Unemployment compensation
- Workman’s compensation
- Net income from self-owned business
Type 2 (Welfare…)
- Public assistance payments
- Welfare payments
- Alimony payments
- Child support payments
Type 3 (Retirement…)
- Retirement income
- Social Security
- Veteran payments
- Supplemental Social Security Income
Type 4 (Other…)
- Earnings from second job
- Disability benefits
- Cash withdrawn from savings
- Income from Estates/Trusts/Investments
- Regular contributions from persons not living in the household
- Royalties/Annuities/Rental Income
- Any other moneys that may be available to pay for camp
Add/remove members by clicking the the +/- icons to the right of a row (bottom on mobile).
If applicable, please comment on any situation that should be considered in addition to your household income. (eg. extraordinary medical expenses or recent loss of job)
This field is for validation purposes and should be left unchanged.