Local Council Service Fee Assistance Application

Parent/Guardian Information

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Amount of assistance apply for? (Up to $75 Council Service Fee)

Does your child receive Free or Reduced Lunches from their school?

Are you participating in the popcorn sale this fall?

Do you or a family member volunteer with your child's Unit?

How many Scouts in your household?

If more than 4 Scouts, please contact the council office at 215-348-7205

Full Name of Scout

First

Last

District:

Unit Type

Unit Number

are that Type

What was your annual family income?

Reason why you are asking for Financial Assistance?

Are there any extenuating circumstances that we need to be aware of?

I certify that my answers are true and complete to the best of my knowledge.