2023 Scholarship Application - Live

Already Registered?*

Yes No

(Click "Yes" if you have already registered for 2023 summer camp.)

Applying for:*

Overnight Youth Camp Family Camp Winterfest New Years Family Weekend

(What kind of scholarship are you applying for?)

Family Camps:*

Chimney Point - Westminster, SC Crier Creek - Columbus, TX Bluffs - Tyler, TX Woods - Tyler, TX

(Which family camps are you interested in?)

Your Marital Status*

Adults in Household*

(Including you)

Children in Household*

Adult 1 Name*

First Name

Last Name

This is your name.

Needs to come to camp on scholarship.

Adult 2 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Adult 3 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Adult 4 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Adult 5 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Adult 6 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

More Adults

If you have more than 3 adults in your household, list the others with their information here.

Children in Your Household

Please name all the children living in your home and state their relationship to you.

Child 1 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 2 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 3 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 4 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 5 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 6 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 7 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 8 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 9 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

Child 10 Name*

First Name

Last Name

Relationship to You*

Needs to come to camp on scholarship.

Birthdate*

More Children

If you have more than 4 children in your household, list them with their inforamation here.

Year

Total Yearly Income* $

Yearly Income Per Person $

Total Yearly Expenses $

They + Friend/Relative Can Pay $

Admin Comments

Award $

Award Notes

Accepted

Offer accepted, camper(s) registered

Pine Cove Household ID

Primary Email*

Secondary Email

Primary Phone*

Secondary Phone

City*

State

ZIP Code*

This information will help us better understand your needs.

Have any of your children been to summer camp at Pine Cove before?*

Yes No

Who and when?

Have any of your children received a scholarship to Pine Cove before?*

Yes No

Who and when?

Is this a foster care situation?*

Yes No

Caseworker Name*

First Name

Last Name

City*

State*

ZIP Code*

Foster Care-Related Comments

How often does your family attend church?*

Weekly Monthly Rarely Never

Why do you attend church?

Is anyone in your household in the military?*

Yes No

Please explain.*

How did you hear about Pine Cove?

What impact do you hope camp will have on your child/children?*

Please explain any extenuating circumstances related to your financial, spiritual or emotional need.*

This information will help us better understand your financial needs.

Parent/Guardian 1 Occupation*

Monthly Income 1* $

Gross (before taxes)

Yearly Income 1 $

Gross (before taxes)

Parent/Guardian 2 Occupation*

Monthly Income 2* $

Gross (before taxes)

Yearly Income 2 $

Gross (before taxes)

Do you receive child support income?*

Yes No

Child Support Income* $

Monthly amount

Yearly Child Support Income $

Do you receive foster care income?*

Yes No

Foster Care Income* $

Monthly amount

Yearly Foster Care Income $

Is either parent/guardian receiving unemployment or disability?*

Yes No

How many parents/guardians are receiving unemployment or disability?

1 2

Previous Occupation*

(Parent 2) Previous Occupation*

How long have they been unemployed?*

(Parent 2) How long have they been unemployed?*

Previous Monthly Income* $

(Parent 2) Previous Monthly Income* $

Monthly Unemployment Income* $

(Parent 2) Monthly Unemployment Income* $

Any workers comp or disability income?*

Yes No

(Parent 2) Any workers comp or disability income?*

Yes No

Disability/Workers Comp.* $

Monthly amount

(Parent 2) Disability/Workers Comp.* $

Monthly amount

Yearly Unemployment Income $

Yearly Disability/Workers Comp. $

Other Unemployment Comments

Submit Disability Invoice

Upload now (preferred) Mail

To verify your information, you must provide us with a copy of your most recent Disability Invoice. Accepted formats: PDF, JPG, PNG, TIF, or a ZIP file containing any of those formats. If you are unable to upload your Disability Invoice, you may email (scholarships@pinecove.com) or mail it to us instead. Your scholarship application WILL NOT BE PROCESSED until we receive your Disability Invoice.

Disability Invoice*

No File Chosen

File uploads may not work on some mobile devices.

Pine Cove Mailing Address:
Pine Cove Scholarship Committee
P.O. Box 9000
Tyler, TX 75711

Submit Federal Tax Return*

Upload now (preferred) Mail

To verify your information, you must provide us with a copy of your most recent Federal Tax Return form. We only need the first 2 pages. Accepted formats: PDF, JPG, PNG, TIF, or a ZIP file containing any of those formats. If you are unable to upload your Tax Return, you may email (scholarships@pinecove.com) or mail it to us instead. Your scholarship application WILL NOT BE PROCESSED until we receive your Tax Return.

Tax Return File 1*

No File Chosen

File uploads may not work on some mobile devices.

Do you need to attach an additional document for your Federal Tax Return?*

Yes No

Tax Return File 2*

No File Chosen

File uploads may not work on some mobile devices.

You won't need this if File 1 is a multi-page file containing both required pages.

Pine Cove Mailing Address:
Pine Cove Scholarship Committee
P.O. Box 9000
Tyler, TX 75711

Monthly Housing* $

Morgtage, Rent, etc.

Monthly Utilities & Groceries* $

Monthly Auto* $

Car payments, insurance, gas, etc.

Monthly Medical Bills $

Not covered by insurance.

Monthly Non-Morgtage Debt $

Credit cards, student loans, etc.

Yearly School Tuition $

For any students in the household.

Yearly Housing $

Morgtage, Rent, etc.

Yearly Utilities & Groceries $

Yearly Auto $

Car payments, insurance, gas, etc.

Yearly Medical Bills $

Not covered by insurance.

Yearly Non-Morgtage Debt $

Credit cards, student loans, etc.

Paying for Camp

Overnight Youth Camp Cost: Standard week is $1,499 (includes $200 deposit).

Winterfest: $359 (includes $50 deposit).

Paying for Camp

Family Camp Cost: The cost for family camp can vary greatly depending on the size of your family and age of your children. A typical week of family camp can cost between $2,700 and $6,000 for an all-inclusive experience.

How much can you afford to pay for camp?* $

Total for all your children or family.

Scholarship Terms:

All of the scholarships we award are partial.
You will have to pay the camp deposit when you register.
Once you register and pay the deposit, the scholarship will be applied. You will then be able to add a monthly payment plan.
If on a payment plan, camp needs to be paid in full by May 1st.

I understand and agree.

Digital Signature*

Type your name, indicating that the information on this application is complete and accurate to the best of your knowledge.

Family Information (Page 1 of 4)

Children in Your Household

Contact Information (Page 2 of 4)

Your Story (Page 3 of 4)

Financial Information (Page 4 of 4)

Income

Expenses

Paying for Camp

Paying for Camp