USA Chess Summer Chess Camp Scholarship Application Form

PART I
Please indicate which camp location you are applying for:________________________________

Morning, Afternoon or All-Day Session:___________________________________________

Student Name:______________________________________________________________

Street Address:______________________________________________________________

City, State, Zip:______________________________________________________________

Home Phone: ______________________________Cell Phone:_______________________

Email: ___________________________________

Grade Next Fall _____________Gender:_________________Age:____________________

Mother’s Name:_____________________________________________________________

Mother’s Work Phone:________________________________________________________

Father’s Name:______________________________________________________________

Father’s Work Phone:_________________________________________________________

What is the gross yearly income of all persons in your household?______________________

Does the applicant receive free or reduced lunch?*___________________________________
*If so, please attach statement from school principal or school cafeteria manager verifying this.

PART II
Essays and Recommendation letters:

1. Scholarship applicant must write an essay of 50 - 100 words on why they would like to attend this camp and what they expect to learn by attending. This essay must be in the applicant’s own handwriting.
2. Parent must include a note describing  how the applicant will benefit from this camp.
3. You must include two letters of recommendation from two current teachers (on school letterhead) of the scholarship applicant. Issues to be addressed in these letters should include: Applicant’s classroom behavior, overall academic performance, interaction skills, willingness to learn and any other pertinent information.
    

PART III
All information provided will be held in confidence and will be used only in determination of scholarship recipients. Please check that you have included everything in your application packet:

            ____Application Form
            ____Current school-year report card
            ____Two sealed recommendation letters from teachers
            ____Verification of financial status or verification from school of free-lunch program
            ____Two essays: one from applicant and one from parent

PART IV
Honor Statement: By signing this form, I hereby state that all the information enclosed in this application is true, and that no documents have been forged, altered or falsified.

 Applicant signature:_____________________________________________Date:___________

 Parent signature:________________________________________________Date:___________

USA Chess provides one (1) scholarship for each camp on the National Summer Chess Camp Tour. Please make sure that you read through the entire application and that all answers are completed. Please understand that a student receiving a USA Chess, Inc, scholarship is not automatically enrolled in a camp session. Once the award letters are mailed, you will be given 10 (ten) business days to respond/register. If you fail to respond, then the scholarship will be given to the next person on our list. Scholarship packets must be RECEIVED by May 1, 2010. Please send the application packet to: Attn: Scholarships, USA Chess, 18911 Forest Bend Creek Way, Spring, TX 77379.