311 NW Lewisburg Ave.

Corvallis, OR 97330

May17, 2018

Thank you for your interest in Chintimini Wildlife Center’s Youth Education Programs!

We are excited to announce that we can offer 50% scholarships to each of our 11 camps this year! To those who qualify, Chintimini will provide one 50% scholarship per camp. Scholarships are limited to one per family.

An Application for Scholarship is enclosed. Scholarships are determined by assessing the total gross annual income to the federal poverty guidelines and low-income percentages. Please provide copies of all your income so that we may determine if you qualify. If you receive Oregon Trail benefits, you only need to provide a printout that shows the income that you reported to the state and the amount they awarded you in cash and/or food assistance. You can obtain this printout at the front desk of your local Department of Human Services (DHS) office. Additionally, if your application is chosen, we ask that each child write a paragraph telling what they love most about nature.

Once you have gathered your information and filled out the paperwork, contact me by phone or email to set up an appointment. Get your applications in early, as scholarships will be granted via qualifying income and on a first-come, first-served basis.

If you have any questions or concerns, please feel free to contact me via phone or email. My contact information is listed below. I look forward to hearing from you soon.

Sincerely,

Ronda Wiggins

Chintimini Wildlife Center

Youth Education Program Director

Email:

Application for Scholarship

Please fill out the following information.

Once all required information is submitted, it may take up to one week to verify all of your information.

You will be contacted with the allocation amount that we are able to provide.

Child’s Information

Child’s Name______Age______

Address______City______Zip______

School______Grade______

Name of Parents or Legal Guardians______

Home Phone______Cell Phone ______Work Phone______

What is your program of interest?______

Financial Information

Name of Parent(s)______

Number of Adultsin Household_____ Number of Children____

Names/Ages of Children______

Number of Children in Program______

Total Household Income: Wages $______TNAF $______SSI $______

Monthly Child Support $______Grants/Scholarships $______

Oregon Trail Benefits per Month $______

Total Household Income (Add ALL above amounts.) $______

Considerations

Are there any special circumstances that need to be taken into consideration? (Examples: single parent, parent(s) in school, participation in other programs, seasonal workers)

______

The program fee minus the 50% scholarship is the amount you owe for the program. This amount must be paid in full by the first day of the program.

I certify that the above information is accurate and completed to the best of my knowledge. I give Chintimini Wildlife Center permission to verify all of the above information. I understand that any incorrect information will result in the immediate disqualification for the requested discount.

Parent Signature______Date______