CWA Local 1180 Summer Camp Scholarship 2023

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• *

  Member/Parent or Legal Guardian

  • Member/Parent
  • Legal Guardian
• * Member's Home Address:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Work Phone:
• * Cell Phone:

Child #1-3's Information

• Union member’s dependent must be active for supplementary benefits to get a $100.00 scholarship toward the camp of their choice.

• * Child #1's Full Name:
• * Child #1's Birth Date:
• *

  Child #1's Gender:

  • Male
  • Female
• Child #2's Full Name:
• Child #2's Birth Date:

• Child #2's Gender:

  • Male
  • Female
• Child #3's Full Name:
• Child #3's Birth Date:

• Child #3's Gender:

  • Male
  • Female

Child #1-3's Camp Information

• All scholarship checks are sent directly to the camp. Register your child at the camp you have chosen. Due to high volume and the “first-come, first-served basis” at camps, we suggest you complete the physical examination at your child’s doctor usually required by the camps as soon as possible.

• * Child #1 Camp Name:
• * Child #1 Camp Phone Number:
• * Child #1 Camp Full Address:
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• Child #2 Camp Name:
• Child #2 Camp Phone Number:
• Child #2 Camp Full Address:
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• Child #3 Camp Name:
• Child #3 Camp Phone Number:
• Child #3 Camp Full Address:
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Child #4's Information

You may add a maximum of 1