Return your completed forms and registration deposit in one of the following ways:
1) Mail to Camp Navigate, P.O. Box 3687, Terre Haute, IN. 47803 2) Drop off at The Life Center, 3000 College Ave, Terre Haute, 47803, (Please submit in the black mailbox
at the southeast door by the ramp) 3) Scan & Email this form to [email protected]
For additional information you can contact us at 812-201-4862 or visit www.campnavigate.org
Welcome! Thank you for choosing Camp Navigate! We have included a brief overview of our mission and purpose. We would also like to take this opportunity to introduce ourselves. We are excited for the arrival of summer and are looking forward to meeting you and your child! Our summer will be full of adventure and fun as we learn about leadership, teamwork, how to be a better student and future employee! There will be swimming, coding, outdoor activities, a talent show, healthy meals and snacks (maybe even some from your child’s garden), dining out and plenty of field trips, too! What’s new for Summer Camp 2019? This summer we are introducing three new programs! Our new “Choose 2 Lead &Serve” for our Middle School campers (information included in this packet); “Coaching a Mentor” (our mentors will now be coached by experienced teachers and school principals on a weekly basis); and our “Warm Hearts Café” (a coffee shop operated by our 5th-8th graders and funded by the Wabash Valley Community Foundation). For additional information on all these new programs, please visit us at www.campnavigate.org. CAMP NAVIGATE MISSION STATEMENT Connecting Students with Employability Skills and Traditional Values to ensure their Successful Futures. Who are we? We are comprised of a management staff with over 50 years of combined youth experience who have joined forces with a dedicated Board of Directors and of some of our community’s most successful and committed educators and businessmen/women to develop Out of School Programs with a purpose! Camp Navigate offers a high quality and engaging summer camp for children pre-K to 8th grade. We are focused on developing employability/soft skills, promoting healthy habits, and creating servant-leaders. Our curriculum has been shaped around research conducted nationally and at the state level, which demonstrates soft skill training needs to be done not just within the adult workforce, but also during the earlier years. The vision of Camp Navigate is that all young people in the Wabash Valley have access to this opportunity to apply their academic skills and acquire new competencies that their future employers will desire, while supporting their year-round learning and well-being DATES AND HOURS June 3th through August 2rd, Monday through Friday, 7:00 am to 5:30 pm. LOCATION The Life Center, 3000 College Ave., Terre Haute REGISTRATION Additional registration forms are also available at Baesler’s Market, Open Door Bookstore, Vigo County Library (Main Branch), and The Life Center at 3000 College Ave., Terre Haute. Visit us at www.campnavigate.org and on Facebook. CONTACT INFO For any additional questions please contact us at any time. You may reach us by phone at 812-229-3214 or 812-201-4862 or email us at [email protected].
Go to our Facebook page at Camp Navigate for up to date information.
Camp Navigate’s Three Focus Areas
Employability Skills Workforce leaders have long been describing a gap in competencies among recent graduates revolving around soft skills, more recently referred to as employability skills. These desirable qualities apply across a variety of jobs and life situations and are crucial in preparation for college and career success. More often than not, they are developed at an early age in life.
Camp Navigate offers an opportunity for young people to develop, not only employability skills, but also desirable life skills through socialization, by learning the values, attitudes, and actions of others, while also building relationships with new and old friends. We are committed to helping young people develop the ability to effectively communicate and to think critically and creatively while collaborating with others. Our campers will also enjoy fun activities that will encourage such employability skills as entrepreneurship, project management, and how to handle emotional setbacks, which will in turn help them to later transition successfully from the early years of learning to high school then college or a career.
Healthy Habits Sure, eating well can be challenging — family schedules are hectic and convenient; pre-packaged food is often more appealing. But at Camp Navigate, we reinforce healthy habits in the hopes that your child will develop the ability to make healthy choices for the rest of his or her life and throughout his or her career. Maintaining healthy habits enables one to lead a life with less stress and a positive attitude – which is beneficial personally and professionally. Employees who know how to set fitness goals and stay motivated to exercise are typically goal-oriented and focused individuals. Additionally, healthy and fit employees also tend to have higher levels of self-confidence and are more likely to inspire confidence in others around them.
Servant-Leadership Servant-leaders display a genuine desire to serve others for the common good and collective human development. Camp Navigate believes in offering leadership training with Christian principles, because we believe this approach to leadership is powerful and impactful. A servant-leader chooses to serve others, regardless of seniority, race, ethnicity, socioeconomic status or faith. As a result, servant-leaders have the capacity to transform and effectively bring about change within not just individual followers, but also within entire organizations.
The Leadership Team Eleanor Ramseier – Camp Navigate Director Eleanor has been serving youth in the Wabash Valley for 27+ years. She began volunteering as a youth worker alongside her husband in 1990. In the most recent past, as Executive Director of the local YMCA, she helped develop and oversee the youth activities as well as the summer camps. She is the mother of three awesome adult children. She has always had a desire to encourage youth to find their passion, set goals and be strong in their faith! With Camp Navigate she can now combine these passions with another aspiration she has– developing youth to succeed in our community’s workforce! She loves spending time with family and friends, running, hiking, and anything adventurous. What excites you most about Camp Navigate? “That this community has overwhelmingly embraced the philosophy of Camp Navigate! In addition, we are bringing awareness to the importance of instilling Employability Skills along with Traditional Values into the lives of our children-our most important asset for the future!
Katelyn Ellinger – Program Director We are so blessed to have Katelyn as a part of our Camp Navigate Team! In Katelyn's words, "I was born to put my whole heart into our youth. My day is filled with LOVE from littles, they teach me so much!" Katelyn starts her day at Fuqua Elementary as a Special Education Assistant and continues it at Camp Navigate’s After-School Care as the Program Director! During the summer she will assist in designing and Co-Directing our programs at camp. She has two years completed at Indiana State University in Elementary Education and plans to further her education with the end goal being a kindergarten teacher. Some of her favorite days are spent with friends, her fur babies and being outdoors in the sunshine!
What excites you most about Camp Navigate? “The Camp Navigate team leads our community’s youth in such a positive way. We learn while having fun, that is my favorite! My adventure at Camp Navigate is very fitting; it allows me to use my organizing skills, creativeness, and passion for kid’s all-in-one. It’s all for the kids and their future!"
Suzy Spears – Administration Coordinator Suzy grew up in the north suburbs of Chicago. She attended Indiana State University and graduated with an Elementary Education Degree. It is there she met her husband and continued on to have two daughters (14 and 17). She pursued different career paths including teaching special needs students, banking, and now administrative work. She truly enjoys combining all her skills into her new position at Camp Navigate. She loves the challenge of learning new tasks as well as acquiring new bookkeeping certifications for her current duties. She is very involved in her church and different ministries. One of the things she has a passion for is fostering. Her family has fostered for 7 years and has had a total of 15 kids. She also loves the Chicago Cubs, time with friends and family, taking the dogs for walks, and enjoying the outdoors.
What excites you about Camp Navigate? “The kids are truly a blessing!” I am so thankful to be working in an environment that has the same passion for kids, that they can pursue their dreams, think big, treat others kindly, and then give them skills to get them there.”
Look what’s NEW at Camp Navigate! The staff at Camp Navigate have been working hard these past few months to create even more exciting
programs for our summer campers! Check out our three newest programs!
“Coach a Mentor” – We have had so many current and retired educators asking how can they get involved with Camp Navigate. We love this request, yet for them to give up an entire summer to be a mentor is difficult. Thus, we have created our “Coach a Mentor” program! This summer each classroom Mentor will have a part time experienced educator who will be coaching them throughout the summer. Our Camp Navigate Coaches are more than excited to play such a significant role in developing our youth and we are more than blessed to have them! We are so honored that so many choose Camp Navigate to share their gifts and talents with!
“Choose 2 Lead & Serve” – This summer our Middle School campers will have the choice to be a Junior Camp Mentor for 2 days a week with a program that is specifically for our 6th-8th grader campers. This program is designed for those campers that desire to develop their leadership skills while serving at Camp. Please see the registration form for more details.
“Warm Hearts Café” – We are so thankful for our newly awarded Youth Grant from the Wabash Valley Community Foundation, and with this gift, Camp Navigate will be creating young entrepreneurs! Every morning this summer when parents drop off their campers they will be able to purchase a hot cup of coffee or tea served by our 5th thru 8th graders. We will even have a “pay it forward” jar for any parent that would like to purchase a cup for someone else! We have already reached out to two local companies and have donations of coffee beans from Starbucks on Wabash, Chick Fil A, and special coffee beans from Nicaragua! Needless to say, our parents are in for a special treat from our young campers!! These campers will be learning such skills as inventory, customer service, budgeting, teamwork, creativity, communication, entrepreneurship, marketing, how to count back change, and so much more.
Middle School Parents/Guardians! We have developed a program for your young adult to have a fun, purposeful Summer here at Camp Navigate
Our NEW 2019 Middle School Summer Camp Program – “Choose 2 Lead & Serve” was designed specifically for your 6th-8th grader!
At Camp Navigate we strive to encourage leadership, independence, responsibility, accountability, teamwork and so much more. Middle school is especially a time when kids will need to begin to make wise choices on their own. We hope that our new “Choose 2 Lead & Serve” Middle School program will reinforce the positive rewards of right choices. This program has been designed to encourage and develop Self-Management in many areas such as behavior, time, conflict resolution, and servant leadership.
At the end of every summer our Middle School campers have continually asked to return and serve at Camp in some capacity. We are excited and encouraged of their desire to be a part of Camp Navigate and work alongside us. This summer we are giving ALL Middle School campers the opportunity to Choose
2 Lead & Serve and join us as a volunteer Junior Camp Mentor for 2 days a week!
Tuesday, Thursday, Friday will be spent enjoying age-appropriate camp activities with their friends - swimming, outdoor activities, education enrichment, STEAM, coding, field trips, visits to local businesses, guest speakers, and so much more! The tuition for these 3 days will be $95.00
Monday and Wednesday will be tuition FREE and will be by invitation only. On these days Middle School campers who have applied for a Junior Camp Mentor position and have shown great leadership throughout the current week, will be assigned and paired with one of their peers to perform various camp responsibilities during the upcoming week as a Junior Camp Mentor. They will take their skills to a new level as they work alongside our Camp Mentors!
Our desire is that this new program, Choose 2 Lead & Serve will teach the importance of Employability/Soft skills and will help prepare Middle School students for future opportunities with job and college applications. Additionally, each Middle School camper will receive a Camp Navigate “Choose 2 Lead & Serve” Certificate at the end of camp.
If you would like for your child to be part of this new program please call Eleanor at 812-201-4862 or email at [email protected] for additional information.
2019 Summer Camp Weekly Themes
"If You Want Your Children to Be Intelligent, Read Them Fairy Tales. If You Want Them to Be More Intelligent, Read Them More Fairy Tales." – Albert Einstein
This summer we will be focusing on all the great lessons from some of your favorite familiar and not so familiar Fables and FairyTales! Our Weekly Themes also include some recognizable quotes full of wisdom to encourage our campers that the sky is the limit as they begin to “write their own story!” We are going to love encouraging our campers with these timeless Fables and Fairytales...we also realize that summer camp would not be summer camp without some SUMMER FUN!!! There will be Swimming, Castle Building, Knights and Princesses, Creative Indoor and Outdoor Activities, S.T.E.A.M. Projects, Field Trips, Coding, our End of Summer Talent Show, a Family Cookout, and so much more!
WEEK ONE – “Never Give Up. Great Things Take Time” The Tortoise and the Hare (Determination, Patience, Dedication, GRIT) By exercising a sense of patient determination, you can accomplish more than those around you ever imagined. Don’t let others discourage you. Stay true to your goals and be focused in your efforts.
WEEK TWO – “Community over Competition” The Legend of the Elephant and the Monkey (Collaboration, Teamwork, Critical Thinking) The Elephant and the Monkey grew to discover that despite their differences they could accomplish more together than separately. We should look for opportunities to cooperate with each other rather than to compete.
WEEK THREE –“Have Courage and Be Kind” Cinderella (Adversity, Kindness to others, Anti-Bullying) In Cinderella we see how even in the midst of cruel people with negative actions, we can rise to be kind to others and often times we are rewarded for it. We learn that sometimes it takes courage to be kind to others.
WEEK FOUR – “I’M Possible, not IMpossible” The Story of the Two Seeds (Dream Big, Think Positive, Entrepreneurship) The two seeds had two completely different perspectives on what they should do. While one wanted to grow big and strong the other one was lazy and hesitant. Don’t let things hold you back. Strive to be the best you can be – nothing is IMpossible with a little determination and hard work!
WEEK FIVE - “ Alone We Can Do So Little; Together We Can Do So Much More “ The Stone Soup (Citizenship, Leadership, Innovation, Teamwork, Community, Creativity) The story of the Stone Soup demonstrates that sometimes we may be the one that needs to create a plan. Once a plan is established, we realize that working together is the best way to complete the task! This week we will also discuss the teamwork of our founding fathers.
WEEK SIX – “You Don’t Have to Be Perfect to Be Amazing” Beauty and the Beast (Acceptance of others, Diversity, Respect) In the story Beauty and the Beast, Bel learns how to look into the heart of the Beast and see the gentle person underneath. Too many times we judge others by their outward appearance, we will learn the true qualities of a friend.
WEEK SEVEN “For Where Your Treasure Is, There Your Heart Will Be Also” The Elves and the Shoemaker (Generosity, Kindness, Gratitude) In this Fable the Shoemaker is so blessed by the kindness of the Elves that he wants to bless the Elves in return. This week we will learn the gift of giving to others. We will also celebrate with a “Christmas in July” celebration this week.
WEEK Eight “ Be Your Own Kind of Beautiful” The Fox and The Crow (Learn to think before Acting, Wisdom, Self-Worth) In the story of The Fox and The Crow, the crow was so taken by someone else’s false flattery that he lost it all. We will learn how to appreciate that small voice inside of us, encouraging us that we were wonderfully and beautifully designed.
WEEK NINE “Whistle While You Work” Snow White and the Seven Dwarfs (This last week we will learn that there is joy in a job well done) We have worked and played hard all summer long. This week we will enjoy all of our accomplishments this summer with a fun week of camp as we realize the rewards of a job well done!
Camp Navigate Weekly Rate Sheet
Classification Rate
Full Time Camper $105.00 per week Monday – Friday 7:00 a.m. – 5:30 p.m
Middle School Camper 95.00 per week Tuesday, Thursday, Friday Camp, 7:00 a.m.-5:30 p.m. Monday and Wednesday Junior Mentor program, 7:00 a.m – 5:30 p.m. (Please see attached Middle School page for details on our new Junior Mentor Program)
Financial Assistance and Discount Opportunities.
To be eligible all children must live in the same household
(discounts cannot be combined)
Multiple Siblings 15%
Each additional camper after the 1st at full price.
example: FT $105 for 1st child, 15% off next children, $89.25 ea.
Military 15%
15% discount on all children.
example: FT $89.25 for all children.
Foster Children Subsidy (limited funds available) 50%
Families who are fostering children are eligible to receive 50% off per child living in their home.
Financial Assistance opportunities are available Limited funds are available for those who financially qualify through our Caulder Huff Johnson Scholarship
Fund and Foster Family Support Fund. If you are interested, please fill out the scholarship application and
attach it to your registration form to see if you qualify for a 50% or 75% reduction in weekly fees.
Camp Navigate 2019 Summer Camp Registration June 3rd to August 2nd, Monday – Friday 7:00 am to 5:30 pm
The Life Center, 3000 College Ave., Terre Haute, IN RATE SHEET / DISCOUNTS / FINANCIAL ASSISTANCE INFORMATION ATTACHED
Total Registration Fees: 1st Camper Name:
WEEK THEMES Yes No June 3-7 Never Give Up, Great Things Take Time June 10-14 Community Over Competition June 17-21 Have Courage and Be Kind June 24-28 I’M Possible, not IMpossible July 1-3 Alone We Can Do So Little, Together We Can Do So Much… July 8-12 You Don’t Have to Be Perfect To Be Amazing July 15-19 For Where Your Treasure Is, There Your Heart Will Be Also July 22-26 Be Your Own Kind of Beautiful July 29-Aug 2 Whistle While You Work 2nd Camper Name:
WEEK THEMES Yes No June 3-7 Never Give Up, Great Things Take Time June 10-14 Community Over Competitions June 17-21 Have Courage and Be Kind June 24-28 I’M Possible, not IMpossible July 1-3 Alone We Can Do So Little, Together We Can Do So Much.. July 8-12 You Don’t Have to Be Perfect To Be Amazing July 15-19 For Where Your Treasure Is, There Your Heart Will Be Also July 22-26 Be Your Own Kind of Beautiful July 29-Aug 2 Whistle While You Work
DISCOUNTS: Sibling Discount Military Discount Foster Care Subsidy Caulder Huff Johnson Scholarship Applicant
All charges including Registration Fees will be withdrawn on my behalf in the following manner.
I am authorizing a bank draft from my checking account and I have attached a voided check I am authorizing a credit card draft and I have provided all the information below Credit Card type: Visa MasterCard CSC: __ __ __ (back of card) Name on Card: Authorized Signature: Card Number: Expiration Date: Billing Address: Billing Zip Code:
I have the legal authority to register the child/children named on this form and to the best of my knowledge the information on this application form is complete and accurate. I understand that my application will not be processed unless it includes the full fee or automatic draft authorization. In the event I cannot be reached in an emergency, I hereby give permission to the director of the program or their designee to secure emergency medical services, including transportation and medical care. I also give permission for the attending physician to order injections, anesthesia or surgery for this child as named above. I understand that medical and accident insurance is the responsibility of the parent or guardian. I understand that I may revoke this release by written request presented with a 48 hour prior notice.
The Non-Refundable Registration Fee is $35 per child /$70 per household and is must be accompanied with this form.
The Weekly fee is $105.00 per camper. Choose your weeks! Choose one or Choose them all!
Camp Navigate Summer Day Camp 2019 Registration v Please drop off the completed registration form and the registration fee to:
The Life Center, 3000 College Ave. Terre Haute. Please submit in the black mailbox by the Southeast door by the ramp. v Or you can mail to: Camp Navigate, P.O. Box 3687 Terre Haute, IN, 47803. Or scan and email to: [email protected]
v You MUST provide a copy of child’s immunization record.
v Be sure to fill ALL pages of the registration form For assistance, call 812-229-3214 or email at [email protected]
v For additional registration forms you may go to www.campnavigate.org
CAMPER (must be siblings or fostered child to register on the same registration) First Name: Middle Initial: Last Name:
Date of Birth: / / Gender: Age: Grade in Fall 2019: Shirt Size: YS / YM / YL / S / M / L / XL
Race: African American Asian American Indian White Multi-Racial Native Hawaiian/Pacific Islander Other
Physical Conditions/Special Needs: Medications/allergies:
To better serve your child, please indicated if he/she has been diagnosed with any of the following: ADD/ADHD Convulsion Bleeding/Clotting Disorders Autism Asperger’s Fragile X Cerebral Palsy Bipolar Dis. Tourette Rett Syndrome Down Syndrome Chronic Health Problems Asthma/Severe Allergies Diabetes Heart defect/disease Other ____________________________ Does this child have an IEP (Individual Education Plan) Yes No First Name: Middle Initial: Last Name:
Date of Birth: / / Gender: Age: Grade in Fall 2017: Shirt Size: YS/ YM / YL / S / M / L / XL
Race: African American Asian American Indian White Multi-Racial Native Hawaiian/Pacific Islander Other
Physical Conditions/Special Needs: Medications/allergies:
To better serve your child, please indicated if he/she has been diagnosed with any of the following: ADD/ADHD Convulsion Bleeding/Clotting Disorders Autism Asperger’s Fragile X Cerebral Palsy Bipolar Dis. Tourette Rett Syndrome Down Syndrome Chronic Health Problems Asthma/Severe Allergies Diabetes Heart defect/disease Other Does this child have an IEP (Individual Education Plan) Yes No
PARENT/GUARDIAN Name: Relationship to Child:
Address: City: State: Zip: Date of Birth: / /
Employer: Would you like to opt in for text message alerts:
Phone (work): Phone(cell):
Email:
Name: Relationship to Child:
Address: City: State: Zip: Date of Birth: / /
Employer: Phone (work) (cell):
Email:
Emergency Contact/Authorized Pick-Up (anyone picking up your child must be: at least 18+ and must show photo ID)
In addition to the parents/guardians listed above, I authorize the following to pick up the child(ren) and or be contacted in an emergency: Name: Relationship to Child: Phone (work): Cell:
Name: Relationship to Child: Phone (work): Cell: Physician/Insurance Information:
Insurance Carrier: Policy Number: Physician Name: Phone: Preferred Hospital in the event child needs to transported for medical attention:
1st
2nd
1st
2nd
Swimming Ability (This page must be filled out for each child attending)
Please check the swimming ability of your child: ____Non- Swimmer: not able to swim 50 continuous feet without dog-paddling or interrupting a stroke to stand in the water, or both. ____Beginner: able to jump feet-first into water deeper than camper is tall, level off, and begin swimming. Capable of swimming 50 continuous feet, including a sharp turn to return to the starting place. ____Swimmer: able to jump feet first into water deeper than camper is tall, level off, and begin swimming. Capable of swimming 100 yards in a strong manner using more than one stroke. Must be able to float.
PARENT AUTHORIZATION AND RELEASE My child has the medical approval to participate in the activities of CAMP NAVIGATE, and in my judgment my child is in good health and physical condition and able to safely participate in the activities of CAMP NAVIGATE. My child has my permission to engage in all activities offered by CAMP NAVIGATE except as noted by me in writing. I further understand that neither CAMP NAVIGATE nor any of its paid staff or volunteer workers can be held responsible in the event of an accident. I promise and agree on behalf of myself, my spouse or partner, or other family members not to sue and agree to waive, release, discharge, and hold harmless and indemnify CAMP NAVIGATE, its agents, employees, members, and volunteers from all claims, demands, rights, and causes of action of any kind, whether arising from my own acts, the acts of my child, or those of CAMP NAVIGATE. I hereby waive all claims of injury or damage, suffered by my child, myself, my spouse, my partner, or other family member in connection with or arising out of the participation of my child in CAMP NAVIGATE’S activities. I certify that my child is amenable to discipline and free from habits or attitudes which would make him/her an undesirable participant.
CAMP ACTIVITY AND TRANSPORTATION AUTHORIZATION I hereby give permission for my child to participate in camp activities and to travel by bus with the CAMP NAVIGATE staff. I understand that only licensed and qualified personnel will operate any vehicle during Day Camp, and that there will be at least one CAMP NAVIGATE staff member present at all times. I agree to release CAMP NAVIGATE, and its officers, directors, and CAMP NAVIGATE’S staff from any and all claims of damages or liabilities which may arise as a result of my child’s participation in camp activities and bus trips.
EMERGENCY AUTHORIZATION I hereby give permission to the medical personnel selected by CAMP NAVIGATE’S camp director or designated CAMP NAVIGATE staff to order X-rays, routine tests and treatment for me or my child, and, in the event that I am not able to communicate or cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director or designated CAMP NAVIGATE staff to hospitalize, secure proper treatment for, and order injection(s) and/or anesthesia and/or surgery for me or my child as named prior. I will be fully responsible for any costs of such treatment, even if not covered by my insurance.
MEDIA RELEASE AUTHORIZATION By checking “Yes” and initialing below, I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of Camper/Student whose names are attached in this documentation. I also grant to CAMP NAVIGATE the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release CAMP NAVIGATE and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
____ Yes ____ No Parent/Legal Guardian Initials ___________
PARENT OR GUARDIAN PERMISSION My signature below indicates that I have the legal authority to sign up the child named on this form and that to the best of my knowledge the information on this application form is complete and accurate. I further understand that this application and the named child’s participation is contingent upon space being available in the program in which I want the child to participate. I also understand that once my registration is confirmed, I must complete payment(s) by the deadlines of said program as outlined prior and that, furthermore, all necessary health, security, and waiver forms must be signed and on file with CAMP NAVIGATE prior to my child attending the program.
Camper/Student name_________________________________________________________ _________________________________________________ __________________________ Signature of Parent or Legal Guardian Date
Camp Navigate’s
Caulder Huff Johnson Scholarship Application Form
Caulder Huff Johnson was only two years old when he tragically and accidentally lost his life on January 2, 2017. His mother, Heather Kumpf Johnson grew up in Terre Haute, and along with Caulder's father, Patrick, they, from the time Caulder was born prayed daily that he would someday glorify God. With great faith and trust his parents know that even now God is in control and through Camp Navigate's Scholarship Fund Caulder's life is doing just that. They would also like others to know that just like a compass can always find due North, that God will never change. No matter what direction your life takes, He is constant. Life is lived best when we trust and allow God to navigate our path (Proverbs 3:5-6). It can sometimes be a bumpy path, but it is ALWAYS the best one. We hope that the Caulder Huff Johnson Scholarship Fund will be a help to your child as he/she begins to choose their path in life.
REQUIRED DOCUMENTATION CHECKLIST:
Ø Completed application. (Please print clearly and fill out the front and back of the application completely.) Ø A copy of the first page of the most recent 1040 Tax Form for EACH ADULT (age 18+) in the household. If you do
not file taxes, you may obtain an IRS transcript by calling the Internal Revenue Service at 1-800-829-1040 or go to www.irs.gov .
Ø Proof of income for EACH ADULT (age 18+) in the household. This includes copies of the last TWO pay stubs, social security or disability checks. You may also submit copies of bank statements showing automatic monthly deposits of government checks. Please, no W-2’s.
Ø If you are requesting that your status as a full time student be considered, you must provide evidence of enrollment.
Ø Documentation of ANY federal assistance you receive such as food stamps, rent subsidy, or Aid to Dependent Children cash assistance.
Ø Free or reduced lunch approval Ø Student loan documentation, if applicable. Ø Additional information may be requested to help determine need.
Applicant’s Information Other Adults in Household’s Information
NAME NAME ADDRESS ADDRESS CITY CITY STATE, ZIP STATE, ZIP HOME PHONE HOME PHONE CELL PHONE CELL PHONE EMAIL EMAIL DATE OF BIRTH DATE OF BIRTH EMPLOYER EMPLOYER EMPLOYER CONTACT INFO
EMPLOYER CONTACT INFO
DEPENDENTS OR ADDITIONAL ADULTS LIVING IN THE HOUSEHOLD
Name:______________________________ Gender Male/Female Date of birth: __________________
Name:______________________________ Gender Male/Female Date of birth: __________________
Name:______________________________ Gender Male/Female Date of birth: __________________
Name:______________________________ Gender Male/Female Date of birth: __________________
Name:______________________________ Gender Male/Female Date of birth: __________________
GROSS ANNUAL INCOME AND EXPENSES:
Household Income Head of Household $ Additional Adults $ Household Expenses $ Employment $ $ Mortgage $ Child Support $ $ Electric/Gas/Water $ Government Asst. $ $ Phone $ Food Stamps $ $ Medical Expenses $ Student Loan Income $ $ Auto Loan $ Other $ $ Other $ TOTAL $ $ TOTAL $
Please tell us your story. Please take the time to describe your circumstances/reason for applying for financial assistance, including any unusual expenses you must meet. (Attach additional pages if necessary.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
I certify that the above information and the supporting documents are correct and complete to the best of my knowledge. I agree to inform Camp Navigate of any changes in my income, family size, or mailing address. I understand that I may lose all Camp Navigate privileges for lack of payment or falsifying information in connection with this application. I understand that my reduced financial assistance will not be automatically extended beyond the aware period and that I must bring updated information annually, or as requested, to qualify. Financial assistance is provided based on household income and available resources. Camp Navigate encourages financial assistance recipients to write a brief note describing how the program has been of help to them. These stories may be shared with Camp Navigate supporters to show them how their contributions are used and to encourage prospective donors to become involved. Would you be willing to share your story ___Yes ___No
Signature _________________________ Printed Name_____________________________ Date __________
