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In order for your application to be complete, we need to have two (2) items listed below: • Send the last 2 weeks of each household members most recent pay stubs; • Current tax return, with W-2s for each household member; • Letter from caseworker outlining financial assistance being received from the State of Maine • A letter from you explaining any unusual circumstancesThe cost of camp is: $165.00/week How much can you afford? $__________This is the amount of assistance being requested $__________Please mark the week(s) of assistance. It should be the same as the week(s) marked onyour camp application._____JUNE 28 - JULY 2 M T W TH F _____ JULY 5 - JULY 9 M T W TH F ______ JULY 12 - JULY 16 M T W TH F _____JULY 19 -JULY 23 M T W TH F _____ JULY 26 - JULY 30 M T W TH F ______ AUG 2 - AUG 6 M T W TH F _____ AUG 9 - AUG 13 M T W TH F _____ AUG 16-AUG 20 M T W TH FI certify that all the information provided is true, and that I will report to Camp LaughingLoon any changes in the household or financial status within a week.Signature of Parent/Guardian________________________________________________________Date_______________________Please be sure to include the following:_____ Completed CLL Camp Application_____ In order for your application to be complete, we need to have two (2) items listed below:• Send the last 2 weeks of each household members most recent pay stubs;• Current tax return, with W-2s for each household member;• Letter from caseworker outlining financial assistance being received fromthe State of Maine• A letter from you explaining any unusual circumstancesRETURN TO:Camp Laughing LoonPO Box 28Saco, ME 04072CLL BOARD APPROVED 11/08Page-0Page-1Page-2Page-3Page-5Page-7Page-8Page-6Page-10Page-11Page-12Page-13Page-14Page-15Page-16