Camp CREATE Financial Aid Application Procedure

Please read carefully!

1) Roads to Success may provide Financial Aid for families that qualify depending on funds available for your location. To
verify your family’s eligibility, we will need a copy of:
a) most recent W-2 Form
OR
b) Public Assistance verification letter

2) To apply for Financial Aid families must complete all the following registration items:
-Financial Aid Application (next page)
-Copy of Family Income verification (examples above)

3) There will be a limited amount of Financial Aid packages awarded and Financial Aid will be granted by need and based
upon availability of space and funds. Please note that Financial Aid may not be available at all camps or every summer.

4) Deadline for submitting Financial Aid application packages will be July 1st.

5) Families that are awarded Financial Aid may be expected to contribute a reduced fee for Camp CREATE service.

6) Applying for Financial Aid does not guarantee award. Any families whose child attends Camp CREATE with award
decisions pending must pay in full to participate in the meantime.

7) Notifications of awarded packages will be announced to each applicant who applied before the deadline via email as
soon as possible.

8) Families selected for Financial Aid must respond that they will accept their award, after which, adjustments will appear
on online accounts. Any recipients who fail to pay fees according to terms of their arrangement will risk losing Financial
Aid.

Please return completed application to:

Attn: Nadine Garcia
billing@roadstosuccess.org
174 East 104th St. New York, NY 10029
 Camp CREATE Financial Aid Application
Please select the option(s) that apply to your Financial Aid request:

I am applying for Financial Aid to attend the following Camp CREATE Sessions:

□Early Session (July 1 -July 12 ) □Mid-Summer (July 15 -July 26 ) □Late Summer (July 29 -August 9 )
st th th th th th

□Full Summer Session (July 1 -August 9 ) st th

Family Information

Parent 1 Name: □ □ Mr. Ms. □ Mrs.__________________________________________________________________

(Primary contact for child)

Home Phone: _____________________________________ Work Phone: _____________________________________

Cell Phone: __________________________________ Email: ________________________________________________

Parent 2 Name: □ □ Mr. Ms. □ Mrs.__________________________________________________________________

(Secondary contact for child)

Home Phone: _____________________________________ Work Phone: _____________________________________

Cell Phone: __________________________________ Email: ________________________________________________

Child’s Information

Child’s Name: ________________________________ Age:_____ Gender: □ □ M F School_______________________

Child’s Name: ________________________________ Age:_____ Gender: □ □ M F School_______________________

Financial Information
*Please attach a copy of
Parent 1 Annual Income:_$________________ Total Number of Dependents ______ the most recent
Parent 2 Annual Income:_$________________ W-2 Form
-or-
Additional Household Income:_$____________
Public Assistance
TOTAL ANNUAL Household Income:_$_____________ Verification Letter

Please attach a copy of your W-2 form or Public Assistance verification letter. We will be using this form to determine eligibility for Financial
Aid to defer the costs of Roads to Success programming.
I agree that the information provided above is true and accurate to the best of my knowledge and that submission of this form grants Roads to
Success permission to investigate the above information for the purpose of determining eligibility for financial assistance for Roads to Success
programs.

Signed __________________________________________________________ Date____________________

Please return completed application to:

Office Use Only
Attn: Nadine Garcia
billing@roadstosuccess.org
174 East 104th St. New York, NY 10029 □ Accepted %____________

□ Denied
Reason_____________________
 Optional: Please use the space on this page to explain why you are requesting
Financial Aid. If you prefer, you may use a separate sheet of paper and attach it.

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