Scholarship Application

The Deadline for submitting a scholarship application is May 5th 2021. You will be contacted with the committees decisions when it becomes available.

 

Please fill out this form as accurately as possible. If you have any questions or difficulties please contact our director, Rabbi Yossi Friedman at (623) 349-1770 or [email protected]

Parent #1 Information:

First Name
Last Name
Employer
Job Title
City of Residence
Marital Status

Parent #2 Information:

First Name
Last Name
Employer
Job Title
City Of Residence
Marital Status

Child #1 Information:
Please fill out the following section separately for each child applying

First Name
Last Name
Date of Birth (mm/dd/yyyy)
Grade (Fall 2021)
Did you receive a camp scholarship for 2020? Yes No Unsure
If yes, please list amount

If applying for only one child please continue here, if applying for multiple children please continue below.

Child #2 Information:

First Name
Last Name
Date of Birth (mm/dd/yyyy)
Grade (Fall 2021)
Did you receive a camp scholarship for 2020? Yes No Unsure
If yes, please list amount

Child #3 Information:

First Name
Last Name
Date of Birth (mm/dd/yyyy)
Grade (Fall 2021)
Did you receive a camp scholarship for 2020? Yes No Unsure
If yes, please list amount

Financial Information:
Parent(s) claiming the applicant for tax purposes. Please answer these questions as listed on your tax returns.

2020 federal tax return: Adjusted gross income
2020 federal tax return: Filing status
Total number of exemptions claimed (Line 6D on your 1040 returns)
# of Children in family
# of Adults in family
Non-taxable income(unlisted)
Expected Income 2021

Statement of Need:
Describe any special expenses or changes in family or economic circumstances over the past year that support your request for financial aid this year. Include known events in 2020 that will impact your family. (new child, bar mitzvah, etc). Please mention if you are a single parent, first generation émigré, special needs family member, or have multiple children attending. OR if a parent has lost their job or work hours were reduced, please indicate the date, the estimated cost of this change, and which parent (one or both parents) was effected. The more details you provide, the better our committee can understand your situation.

Reference:
Please provide a rabbinic or personal reference who may be contacted to confirm the information provided above.

Name:
Phone #:

Tuition Fees Information:

Amount of full tuition
What can you pay towards camp tuition?
How much can you receive from friends or family?
Please explain source
Funding from any other agencies or grants
Please explain source
Total amount requested

Signature:

I confirm that all the information contained above is accurate to the best of my knowledge and I understand that if this information is found to be false I may be disqualified from receiving aid and may be required to return any funds received.

Signature Date

Email (For email confirmation and receipt)