EmailMe Form - Countryside Camp Scholarship Application

All applicants must be entering or returning to post secondary education in September of the current year.

All applicants must have been on Summer Staff during the current year.

Application deadline is Sept 8th.

Video

You will be required to create a video as part of your application. You will want to create that video before you start this application.

Personal Information

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number *

### - ### - ####

Email *

Email will be our primary means of communication.

Church Information

Name of Church Where You Hold Membership or Regularly Attend

City

Denomination

Work History

1) Name of Employer

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Leave blank if you are still employed

Description of Responsibilities

2) Name of Employer

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Leave blank if you are still employed

Description of Responsibilities

Camp Experience

List below any past experience that you may have with summer camps. This includes Camp Shalom and any other camp

1) Camp Name

Including and outside of Camp Shalom

Position and Responsibilities

2) Camp Name

Position and Responsibilities

3) Camp Name

Position and Responsibilities

Education

What post-secondary education will you be ruturning to or entering in September?

Major/Minor

Years Attended

Past School's Name

(if applicable)

Any Additional Notes

Essay Questions

Please answer the following questions.

Why do you need a scholarship?

Tell us about your church/ministry involvement.

What are you passionate about? If you could solve one problem in the world and you were guaranteed to succeed, what problem would you solve? Why?

How do you see yourself differently after the summer compared to before the summer? What part did the summer play in helping you realize more about who God made you to be?

Video Upload

Please upload a video to the platform of your choice (ex. Google Drive, YouTube, Vimeo, etc) and share the URL below. We may use some of this content for promotional purposes.

In the video please include:

1) An introduction of yourself.

2) Tell us about the impact that being on staff at Camp Shalom has made on your life.

3) Tell us a meaningful story that you experienced while on staff at Camp.

4) Tell us why you have chosen your post-secondary education.

5) What do you think God is calling you to in the future?

6) What specific skills have you learned at Camp that will help you in the future?

Video URL

References

Please provide information for two references.

Important: Each reference will be automatically emailed and asked to fill out an online reference form.

1) Name of Reference *

First Last

Email *

Your reference will be automatically emailed and asked to fill out a reference form.

Relationship *

Phone Number

### - ### - ####

2) Name of Reference *

First Last

Email *

Your reference will be automatically emailed and asked to fill out a reference form.

Relationship *

Phone Number

### - ### - ####

Video

Personal Information

Church Information

Work History

Camp Experience

Education

Essay Questions

Video Upload

References

If a confirmation note does not appear after you click "Submit Application," scroll up to see if you filled in all of the required fields.