Camp Cocoon

Our weekend bereavement camp for kids will be held Aug. 2-4, 2024, in beautiful Tallulah Falls, Ga. Applications are now being accepted for campers and adult volunteers.

Learn More

Scholarship Form

Personal Details

First Name *

First name is required field

Middle Name

Invalid characters present

Last Name*

Required *

Email*

Required *

Phone*

Required *

People Soft Number

Not Required

Street Address*

Required *

City*

Required *

State*

Required *

Zip Code*

Required *

Educational Details

High School

School Name*

Required *

City*

Required *

State*

Required *

Cumulative GPA

Not Required

Graduation Date*

Enter High School Graduation Date

Current School

School Name

City*

Required *

State*

Required *

Dates Attended

Not Required

Cumulative GPA

Not Required

Expected Graduation Date*

Enter Current School Expected Graduation Date

Major/Field of Study

Previous Technical School/College/University Attended

Not Required

City

State

Dates Attended

Cumulative GPA

Graduation Date

About You

Extracurricular or Community Activities

Honors/Awards

Employment Details

Current Employer Details

Employer Name*

Required *

Position Title*

Required *

Number of Hours/Week*

Required *

Phone*

Required *

Date Started*

Enter Current Employer Date Started

Date Ended*

Enter Current Employer Date Ended

Address*

Required *

City*

Required *

State*

Required *

Description of Duties/Responsibilities*

Required *

Most Recent Previous Employer Details

Employer Name*

Required *

Position Title*

Required *

Number of Hours/Week*

Required *

Date Started*

Enter Most Recent Previous Employer Date Started

Date Ended*

Enter Most Recent Previous Employer Date Ended

Phone*

Enter a valid phone number

Address*

Required *

City*

Required *

State*

Required *

Description of Duties/Responsibilities*

Required *

Next Most Recent Previous Employer Details

Employer Name*

Required *

Position Title*

Required *

Number of Hours/Week*

Required *

Phone

Not Required

Date Started*

Enter Next Recent Previous Employer Date Started

Date Ended*

Enter Next Recent Previous Employer Date Ended

Address*

Required *

City*

Required *

State*

Required *

Description of Duties/Responsibilities*

Required *

Family Details

Do you live with your parents?

Yes

Are you self supporting?

Yes

Yearly income of Parents? *

Please enter valid value *

Your yearly income ? *

Please enter valid value *

Yearly income of Spouse ? *

Please enter valid value *

How many persons are dependent on your salary including yourself? *

Required *

How many hours per week do you work ? *

Required *

What is the cost of tuition for the coming term? *

Please enter valid value *

What kind of family circumstances affect financial need? (ex: illness, child support, debts, etc.)*

Required *

What other sources of income do you have to help you with your education? (ex: other scholarships, loans, VA benefits, etc.) Please list all amounts and sources of support towards tuition this coming term.*

Required *

Reference Details

Reference 1 Name *

Required *

Reference 1 Phone Number *

Enter a valid phone number

Reference 2 Name *

Required *

Reference 2 Phone Number *

Enter a valid phone number

Reference 3 Name *

Required *

Reference 3 Phone Number *

Enter a valid phone number

1626 Jeurgens Court, Norcross, GA 30093

P: 678.533.6462