Name:_____________________________Age______M/F_____ Address:____________________________________________                ___________________________________________ City/State/Zip:_______________________________________ Phone Home:__________________work:________________

FOR OFFICE USE ONLY Received__________ Week_____Choice_____WL___ Aid requested______ Granted______ Work Scholar______ Notified_______ App#___________Due_______

Work Scholarships: (questions 1-4 only)

1 Week applied for: at (circle one) PINEWOODS BUFFALO GAP OGONTZ.

2 If applying to other CDSS weeks, please list:

3 Special abilities, Check if interested in one of these specific work scholarship jobs.

Dining Hall Manager___	Certified lifeguard/CPR/1st Aid____	Sound system (professional) ____
Doctor/registered nurse (for Family and Campers' Weeks)____		Photographer (professional)____
Other (please specify)______________________

4 Could you attend camp without this aid?________

Named Scholarships: (questions 1-10) (Please try to limit your responses to one page.)

5 How much total aid do you need? $_________________
(Please give a definite figure for the aid requested; "as much as possible" is not a sufficient answer.)

6 Please check any named scholarship that you are applying for. PLEASE READ Scholarship Information FIRST

____ May Gadd	____ Grace Feldman	____ Ellen Bray
____ Phil Merrill	____ Jennifer Lehmann	____ Janie Winkles
____ Michele Godbout	____ John Hodgkin	____ Karl Rodgers/PMM
____ Bruce Weigold	____ Bob and Kathleen Hider

7 Have you ever received a CDSS Scholarship? No_______ Yes_______.
If yes, for what year(s) , week(s) .

8 Are you a full time student? ________ If so, where?

9 If you are employed/self-employed, please list employment and position; if not self-supporting, please explain.

10 Please list dance, music or school groups in which you actively participate (include your position, if any, as leader, musician, singer, or teacher).