KICK Tuition Assistance Application

Tuition assistance will be based on the Federal Income Eligibility Guidelines.

Free and Reduced Lunch automatically qualifies your camper for tuition assistance. A letter from the Dept. of Food and Nutrition or from your child's school is required with each application. Please use the upload file button at the beginning of this form.

If you are not on free and reduced lunch but qualify under the Federal Income Guidelines, please contact Riley Dvorak, at 319-398-7772, for more information.

Tuition Assistance is available on a first come, first serve basis and is limited to one camp, per child, per school year (July 1st - June 30th)

Applications must be received at minimum three business days prior to the start date of the desired camp. Completing this form does not guarantee your child a spot in the camp.

* denotes required fields.
Upload Attachment - Free and Reduced Lunch Letter
Part 1: Camp Information:
  Camp Name Camp ID Camp Dates Camp Tuition
Preference 1*
Preference 2
Preference 3
Part 2 - Health/Medical Release Information:

*Camper's Name

*Date of Birth

*Sex
*Expected Graduation Year

*Parent/Guardian Name

*Phone Number
*Would you like to receive text messages?

*Email Address

*Street Address

*City

*State

*Zip Code

*Alternate Emergency Contact

*Alternate Emergency Contact Number

*Insurance Information

*List any medical conditions (N/A if not applicable)

*List any allergies (N/A if not applicable)

*List any medications the child is taking (N/A if not applicable)
If the named minor child is in need of medical attention, as the result of either illness or injury, I do hereby give my permission for Kirkwood Community College to provide, or see that the necessary care is provided. Additionally, I give the College permission to submit my medical insurance information to any medical provider caring for the named minor child.

*Digital Signature of Parent/Guardian

*Date