Eastern Iowa FCA

2024 Summer Camps Scholarship Request Form

Please complete the form below to request an Eastern Iowa FCA Camp Scholarship. Scholarships will be awarded based on the applicant's need and in the order they are received.

*Please do not complete camp registration until receiving a camp scholarship code from the Eastern Iowa FCA office.

FCA Camp Location

Camper Name (First, Last)

Gender:

Male

Female

Date of Birth

Street Address

City

State

Zip

School

Grade (September 2022)

Church (Name, town)

Parent/Guardian Name(s)

Parent's Phone #s

Student's Phone #

Parent's Email

Student's Email

List FCA camps previously attended

Have you received an FCA Camp Scholarship before

Yes

If yes, what was the amount?

Parents combined gross income (check one)

Under $20,000

$20,000 - $35,000

$35,000 - $50,000

$50,000 - $75,000

Above $75,000

Is this a dual income home

Yes

Single parent home?

Yes

Total number of children in the home?

Camper's comments on desire to attend an FCA Summer Camp:

Parent/Guardian's comments regarding camper's interest in attending a FCA Summer Camp and request for camp scholarship funds:

Today's Date

Thank you for submiting your request for a FCA Camp Scholarship

The Eastern Iowa FCA office will contact you with further details to assist you with camp registration.

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Contact Info

1800 46th St NE, Cedar Rapids, IA 52402, United States

(319) 832-1461

easterniowa@fca.org

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