VOLUSIA COUNTY COMMUNITY ASSISTANCE SUMMER CAMP SCHOLARSHIP APPLICATION 2016

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Naomi Gallagher
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1 VOLUSIA COUNTY COMMUNITY ASSISTANCE SUMMER CAMP SCHOLARSHIP APPLICATION 2016 The eligibility criteria for summer camp scholarships have changed. information before submitting an application. Please review the following Eligibility for summer camp scholarships is as follows: Age - Children ages 5, who have completed Kindergarten, and children age 6-12 (must be entering first through sixth grade) are eligible. Children up to age 17 for City of Ormond Beach Camp T-Rec (Special Needs ONLY). Residency - Children must live and attend school in Volusia County. Proof of child s third quarter report card (dated March 29, 2016) is required. Income Eligibility - Clients must be between 0-200% of the federal poverty guideline. Clients must provide proof of all household income for the past 30 days including pay stubs, unemployment benefits, child support, social security income and disability income, or notarized verification of financial support from others. A work calendar or profit and loss statement is required for those who are self employed. Household size - Client must provide proof of household size with most recent tax return (2015), or SNAP letter (dated within last 90 days), or public housing verification with documentation of household size, or lease. This information will be used to determine eligibility - Failure to provide all requested information at the time of application is cause for denial. Scholarships are awarded based upon available funding allocated within poverty guidelines, income eligibility, and camp site availability. If all funds have been expended, or the requested campsite is full, eligible applicants will be put on a waiting list until an opening becomes available. Please note that changes to camp sites will only be made by County of Volusia Community Assistance Division staff. Applicants are encouraged to submit applications at one of the four locations listed on this application and are given priority. Please note that incomplete applications will not be accepted at the sites. Applications will not be accepted if delivered in person or by mail until after April 21, After April 21, 2016, applications may be submitted in person, or by mail, to the County of Volusia, Community Assistance Division, 110 West Rich Avenue, Deland, Florida However, eligible clients will be put on a waiting list. Faxed applications will not be considered. The County of Volusia may stop accepting applications without notice. For additional information contact Brittany Scott at (386) in DeLand, (386) in Daytona Beach, or (386) in New Smyrna Beach. Child s Name Date of Birth Age Entering into Grade School currently attending Parent or Guardian Name (s) Address City Zip Code Mailing Address (If different) Household Size Number of Adults Number of Children Is the head of household employed? If not, source of income Daytime Contact Number (Cell) (Home) (Work) Choice for Summer Camp Location Signature Date Indemnification: The scholarship recipient shall hold harmless, defend and indemnify the COUNTY, officers, agents and employees from, or on any account of, any and all claims, actions, lawsuits, losses, expenses, injuries, damages, judgments or liabilities of any kind whatsoever arising out of the summer camp program. County Staff Initials Last 4 of Child s SS # County Staff Initials Gross Annual Income Household Size Poverty Percentage

2 Summer Camp Scholarship Information Applications will be available at each Human Services office, all Volusia County Public Libraries, One Voice for Volusia- Community Connector, approved summer camp sites and online at on March 21, 2016 Applications for summer camp scholarships will be accepted at the following locations: Date Location Time Wednesday, April 6, 2016 Thursday, April 14, 2016 Tuesday, April 19, 2016 Thursday, April 21, 2016 Deltona Regional Library 2150 Eustace Ave. Scrub Jay Auditorium Deltona Woman s Club 403 Magnolia St. New Smyrna Beach Thomas C. Kelly Admin. Center 123 West Indiana Ave. 1 st Floor Training Room DeLand City Island Library 105 E. Magnolia Ave. Daytona Beach 9:30 a.m-6:00 p.m. 7:30 a.m. 4:00 p.m. 7:30 a.m.-6:00 p.m. 7:30 a.m.-6:00 p.m. After April 21, 2016 applications may be submitted in person, or by mail, to the County of Volusia, Community Assistance Division, 110 West Rich Ave., Deland, Florida Faxed applications will not be accepted. Eligible applicants will be put on a waiting list until an opening becomes available. Summer camp scholarships cover up to an 8 week period beginning June 13, 2016 through August 5, Please note that if a camp site does not meet the enrollment requirements, you will be notified by County of Volusia Community Assistance Division staff to select another camp site. Please note that the County of Volusia may stop accepting applications without notice.

3 Northeast Sites Bicentennial Park, 1800 Ocean Shore Blvd., Ormond-By-The-Sea, Holly Hill School, 1500 Center St., Holly Hill, (7 week site) R.J. Longstreet Elementary, 2745 S. Peninsula Dr., Daytona Beach, (7 week site) Pathways Elementary, 2100 Airport Rd., Ormond Beach, (7 week site) Palm Terrace Elementary, 1825 Dunn Ave., Daytona Beach, (7 week site) Turie T. Small Elementary School, 800 South St., Daytona Beach, (7 week site) John Dickerson Club 308 South Martin Luther King Jr. Blvd., Daytona Beach, Rossmeyer Family Holly Hill Club, 1044 Daytona Ave., Holly Hill, City of Daytona Beach Midtown Cultural Education Program, 925 George Engram Blvd., Daytona Beach, Ortona Playground, 1206 N. Halifax Ave., Daytona Beach, City of Daytona Beach Police Athletic League Yvonne Scarlett-Golden Cultural and Educational Center, 1000 Vine St., Daytona Beach, City of Ormond Beach South Ormond Neighborhood Center, 176 Division Ave., Ormond Beach, (6 weeks) Nova Community Center (special needs), 440 North Nova Rd., Ormond Beach, (6 weeks) City of South Daytona Parks and Recreation Department James Park Camp, 1700 James St., South Daytona, Mt. Calvary Academy Camp MCA, 700 Bellevue Ave., Daytona Beach, Reign Homeschooling Camp Destiny, 868 George W. Engram Blvd., Daytona Beach, Port Orange Elementary, 402 Dunlawton Ave., Port Orange, South Daytona Elementary, 600 Elizabeth Place, South Daytona, Spruce Creek Elementary, 642 Taylor Rd., Port Orange, Word and Praise Christian Learning 955 Orange Ave., Units 120 & 130, Daytona Beach, Holly Hill Family, 1046 Daytona Ave., Holly Hill, Ormond Beach Family, 500 Sterthaus Ave., Ormond Beach, Port Orange Family, 4701 City Center Parkway, Port Orange, 32129

4 Southeast Sites Edgewater Public School, Edgewater, 801 South Old County Rd., Edgewater, (7 week site) Mary DeWees Park, 178 North Gaines St., Oak Hill, Mary McCleod Bethune Beach Park, 6656 S. Atlantic Ave., New Smyrna Beach, Edgewater Club, 211 N. Ridgewood Ave., Edgewater, Oretha Bell Club, 813 Mary Ave., New Smyrna Beach, City of New Smyrna Beach Alonzo Babe James Community Center, 201 N. Myrtle Ave., New Smyrna Beach, Indian River Elementary, 650 Roberts Rd., Edgewater, Southeast Family, 148 W. Turgot Ave., Edgewater, Southwest Sites DeBary Hall Historic Site, 198 Sunrise Blvd. DeBary, Gemini Springs, 37 Dirksen Dr., DeBary, Orange City Elementary, 555 E. University Blvd., Orange City, (7 week site) Pride Elementary, 1100 Learning Lane, Deltona, (7 week site) Harris Saxon Club, 2329 California St., Deltona, City of DeBary Florence K. Little Town Hall, 12 Colomba Rd., DeBary, FL, Florida Methodist Children s Home 51 Children s Way, Enterprise, Forest Lake Elementary, 1600 Doyle Rd., Deltona, Osteen Elementary, 500 Doyle Rd., Osteen, Spirit Elementary, 1500 Meadowlark Dr., Deltona, Sunrise Elementary, 3155 Phonetia Dr., Deltona, Timbercrest Elementary, 2401 Eustace Ave., Deltona, Four Townes Family, 280 Wolf Pack Run, Deltona, 32725

5 Northwest Sites Boy Scout Hut, 720 N. Frankfurt Ave., Deland, Chisholm Center, 520 S. Clara Ave., Deland, Deland High School Gym, 800 N. Hill Blvd., Deland, T.D. Taylor Middle/High School, 100 E. Washington Ave., Pierson, (7 week site) Lake Helen Club, 493 S. Lakeview Dr., Lake Helen, Brighthouse Spring Hill Club, 462 Green St., Deland, Woodward Elementary, 1201 S. Woodward Ave., Deland, Salvation Army of West Volusia 1240 S. High St., Deland, Temple Learning Center 820 S. Adelle Ave., Deland, Deland Family, 761 E. International Speedway Blvd., Deland, 32724

Growth and Resource Management Department 123 W. Indiana Avenue, Room 200, DeLand, Florida Kelli McGee Director

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