2012 Scholarship Program Recommendation Form

Thank you for taking the time to complete Horizon Arts Camp's online Scholarship Program Recommendation Form. H.A.C. will use the information provided, along with information from the family, to determine the campers that will receive financial support to attend our 2012 summer camp. If you have any questions or concerns, please contact Myanna Adams, Assistant Camp Director, at (416) 558-0922 or myanna@horizonartscamp.org.

Please fill out the entire form - incomplete forms cannot be submitted.


First & Last Name of the Child you are Recommending:
First & Last Name of the Child's Parent/Guardian:
Referee First & Last Name:
Position/Title:
Name of Organization:
Organization Contact Information
Address:
City:
Province:
Postal Code:
Phone Number:
Referee Contact Information
Phone Number:
Cell Phone Number:
Email Address:
How long have you known the child/family and in what capacity?

Are the child's parents separated/divorced?
Who does the child live at home with?
Is the child and/or family experiencing any stressful or difficult life situations? (illness, job loss, etc.) If yes, please explain.

The full cost for one child to attend Horizon Arts Camp for 3 weeks is $1600. Please comment on this family's need for financial support for this child to attend H.A.C.

Is the child experiencing any behavioural problems at home or at school?
If Yes, please explain:

Does the child have any of the following? (check all that apply)
ADD/ADHD Learning Disabilities Autism Spectrum Disorder Epilepsy Diabetes Mental Health Concerns Physical Challenges History of Abuse/Domestic Violence Other None of the Above
If you selected any of the above, please explain:

Please describe the child's interest/involvement in arts programs (music, dance, theatre, visual arts)

How would the child benefit from participation in Horizon Arts Camp?

What would it mean to the family to receive a scholarship for their child to attend Horizon Arts Camp?

Please use the space below to provide any additional information you would like to share about the child and/or family.

How did you hear about Horizon Arts Camp?
In submitting this form, you are confirming that all of the statements made in this recommendation are true to the best of your knowledge. Please Note: When a child's family applies to the Scholarship Program, the guardian(s) are giving permission to the referee to provide information on the recommendation form to Horizon Arts Camp. This includes follow-up phone calls from the Camp to the referee to obtain more information, if required.
Accept