Culture Camp Scholarship Form Name * First Name Last Name Email * Phone number * Address * Social Media Handles http:// Describe yourself (age, ancestry, occupation) * Which Nation do you live on? * Which Scholarship are you applying for? Indigenous Person (Any Camp) Cyclone/ Flood Affected Person (Plan C Camps Only) What is your connection to your Indigenous Community? * If you are applying for our Indigenous Scholarship please tell us who your Mob are/who claims you? How long have you identified for? * If you are applying for our Flood/ Cyclone Affected scholarship, please tell us how you were impacted?* * This also includes those who volunteered, led community initiatives, donated time or resources to rebuilding communities, lost their employment etc Will your children be attending? If yes, please provide their names and ages Please tell us about your household yearly income * Below $50,000 $50,000- $90,000 Above $100,000 Which camp are you applying for? * October 13th-17th 2025 PLAN C X THE RETURNING December 1st-5th 2025 PLAN C X THE RETURNING Accommodation option * Shared Bunk Room Camping (BYO gear) Can you afford to pay a refundable deposit of $75 per adult and $35 per child to secure your position? Yes No Do you have any allergies, mobility issues or are you taking any medication that we should know about? * This information helps us to best care for you while are at camp Thank you!