Council for Exceptional Children - Gwinnett County Public Schools

Council for Exceptional Children
Gwinnett Chapter 0717
Summer Camp/ Program Scholarship Application 2012
Parents,
Please fill out application completely. Applications must be
received by Friday April 27th. Applications will not be accepted after
this date.
WWW.GLRS.ORG - Camp Directory
Mail or Fax Applications to:
Lora Carter
C/O Oakland Meadow School
590 Old Snellville Hwy
Lawrenceville, GA 30046
Fax: (770) 513 -6803
Or email applications to:
Lora_Carter@gwinnett.k12.ga.us
***Please note that INCOMPLETE applications will
NOT be considered for this scholarship***

Council for Exceptional Children
Gwinnett Chapter 0717
Summer Camp/ Program Scholarship Application 2012
STUDENT NAME: _______________________________________________________
AGE: ______________________
STUDENT DISABILITY: _________________________________________________
ADDRESS: _____________________________________________________________
Street City Zip Code
PHONE NUMBER: ______________________________________________________
EMAIL: _______________________________________________________________
SCHOOL ATTENDING: __________________________________________________
TEACHER’S NAME: _____________________________________________________
NAME OF CAMP/ PROGRAM: ____________________________________________
CAMP/ PROGRAM LOCATION: ___________________________________________
STREET ADDRESS
____________________________________________________
CITY STATE ZIP CODE
____________________________________________________
PHONE NUMBER
____________________________________________________
EMAIL OR WEBSITE
CONTACT NAME AT CAMP/ PROGRAM: __________________________________
DESCRIPTION OF CAMP/ PROGRAM: _____________________________________

WHY WOULD YOUR CHILD BENEFIT: ____________________________________
HAVE YOU RECEIVED A CEC SCHOLARSHIP WITHIN THE PAST TWO YEARS?
YES
NO
ARE YOU RECEIVING ANY OTHER FUNDS TO HELP
PAY FOR COST OR CAMP/ PROGRAM: YES NO
NUMBER OF SESSIONS ATTENDING: _____________________________________
TOTAL COST OF PROGRAM: _____________________________________________
I understand that the Council for Exceptional Children is NOT sponsoring a
camp/ program. Maximum to be granted will NOT pay entire camp/ program costs. I
realize that COMPLETED applications are the only ones that will be considered for this
scholarship. The child must be enrolled in a Gwinnett County Special Education class
to be eligible for funds. You will be notified via letter, phone call, or email no later
than Friday May 4, 2012 if your child will receive the scholarship. You will be
responsible for providing confirmation of the camp/ program registration, a contact
person’s name, the address and phone number, and the name of the camp/ program
the check is to be sent.
I understand that if my child receives scholarship funds, the check will be
written to the camp/ program and will be attached to the application. In the event
my child DOES NOT attend the camp/ program, the scholarship funds will be returned
to the Council for Exceptional Children Gwinnett Chapter.
I further understand the CEC is not endorsing or recommending any particular
camp/ program and the CEC is not responsible for ensuring camp/ program quality,
safety, expertise of staff, etc. I will, however, hold CEC harmless for any camp/
program related problem that would arise.
Parent Signature: _________________________________________________
Date: ___________________________________________________________