2022 Pick Along Summer Camp Scholarship Request Form

Preparer Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone*
Work Phone
Email Address*
Relationship to Applicant(s)*
Student Name & Age*
First Last Age
Student Name & Age (for sibling applicants)
First Last Age
Student Name & Age (for sibling applicants)
First Last Age
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I am applying for the week of:*
- June 20-24, 2022 - Beginner Level Camp
- July 11-15,2022 - Intermediate Level Camp
Are you able to contribute any amount to the cost of camp?*
- Yes
- No
If yes, what estimated amount?
Please explain how you feel the student(s) would benefit most from this scholarship opportunity*
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that scholarships are offered based on availability and not guaranteed. Any acceptance of scholarship by applicant will be recognized as an agreement to regulations of conduct defined by the Birthplace of Country Music.
Name*
First Last
Date*
MM slash DD slash YYYY
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in our organization.

Agreement and Signature