Financial Assistance Request

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Financial Assistance Request

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Applicant		Parent/Guardian		Unit		Assistance

Is this for a Youth or an Adult? *
N/A

Youth
Adult
Name of Applicant
N/A

Required First Name Required Last Name
Applicant's Date of Birth
N/A

dd-MMM-yyyy
Applicant's Address
N/A

Required
Street Address Required City Required
County Required State/Region/Province Required
Postal / Zip Code

Are you the parent or guardian of the youth? *
N/A

Yes
No
Requestor Name
N/A

Required First Name Required Last Name
Requestor Email *
N/A
Requestor Phone *
N/A
Name of Parent/Guardian/You
N/A

Required First Name Required Last Name
Parent/Guardian/Your Email *
N/A
Parent/Guardian/Your Phone *
N/A
Preferred Conversational Language(s)
N/A
Is the Parent or Guardian a Registered Volunteer? *
N/A

Yes
No

Unit Type *
N/A

-Select-
Unit Number *
N/A
Are you new to this unit? *
N/A

Yes
No

If this is your first time in scouting, please select yes.
Unit Leader's Name
N/A

Required First Name Required Last Name
Unit Leader's Phone *
N/A
N/A

Unit Confirmation * Unit Confirmation Required

I agree to you contacting the unit leader listed above to confirm the applicant is registered/registering in the above unit.

What assistance are you applying for? *
N/A

Activities
Registration
Activity Level *
N/A

Council
District (e.g. Camporee)
Training (e.g. NYLT)
Activity Name *
N/A
Is the Unit already registered for the event? *
N/A

Yes
No
How much are you able to contribute? USD *
N/A

The funds available for assistance are from grants and are limited. Anything you can pay helps more youth have access to these funds.
Reason for Request *
N/A

Please give a compelling reason why the applicant is in need of assistance.
Signature *
N/A

E-Signature Field
Clear

By signing above, I certify all information is true and correct to the best of my knowledge.

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