JEWISH ISRAEL EXPERIENCE SCHOLARSHIP FORM - Form

JEWISH ISRAEL EXPERIENCE SCHOLARSHIP FORM
APPLICATION DEADLINE: MARCH 1

This application is designed to provide the Scholarship Committee with background information in order to evaluate your request.

Due to limited scholarship funds, our congregation is able to give up to one-third of the total cost of camp (not including transportation).

If you have any questions, please feel free to call Dayna Gershon at 913.663.3047 or via email at education@bnaijehudah.org.

Complete separate registration form for each child participating.

Parent/Guardian Information

* Primary Parent/Guardian First Name

* Primary Parent/Guardian Last Name

* Primary Parent/Guardian Phone

* Primary Parent/Guardian Email

Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian Phone

Secondary Parent/Guardian Email

Who is financially responsible for the child?

Are you currently a member in good standing at B'nai Jehudah?

* What Jewish Israel experience is your child interested in participating?

How long is the experience? If their time in Israel is part of a multi country program, how long will they be in Israel?

Participant Information

* Participant First Name

Participant Preferred Name/Nickname

* Participant Last Name

Participant Birthdate

* Preferred Gender

She/HerHe/HimThey/ThemOther

Need for Scholarship

Please explain any and all circumstances contributing to your need for scholarship.

Financial Details

Due to a limited amount of scholarship funds available, our congregation is able to give up to one-third of the total cost of camp (not including transportation).

* Total Cost of the Progam (Do NOT include domestic travel expenses or incidentals)

* Amount of financial assistance requested from other sources.

* Amount of financial assistance requested from sponsoring organization:

* Maximum amount of family resources:

IMPORTANT INFORMATION: BY SIGNING THIS APPLICATION REQUESTING FINANCIAL ASSISTANCE, THE APPLICANT HEREBY AGREES THAT IN THE EVENT A SCHOLARSHIP IS AWARDED BUT THE STUDENT DOES NOT PARTICIPATE IN THE PROGRAM, PARENTS WILL INFORM THE ORGANIZATION SPONSORING THE CAMP PROGRAM AND REQUEST THAT THE FUNDS BE RETURNED TO THE CONGREGATION. THE APPLICANT ALSO AGREES THAT IN THE EVENT A SCHOLARSHIP IS AWARDED, THEY WILL PROVIDE THE CHAIRMAN OF THE SCHOLARSHIP COMMITTEE WITH A THANK YOU NOTE FOR THE APPROPRIATE SCHOLARSHIP FUND AND A MINIMUM ONE-PAGE WRITTEN CRITIQUE OF THE EVENT SO THAT RECORDS CAN BE MAINTAINED ON THE EVALUATION OF STUDENTS ATTENDING SUCH ACTIVITIES.

Parents please type your name here as signature of this application

Date Submitting Application

Thank you for filling out the Jewish Israel Experience Scholarship application. We will get back in touch with you shortly.