Scholarship Short Form

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Parent/Guardian's Name*

First Last

Camper's Name(s)*

Is your camper Jewish?*

Which do you identify as?*

Annual Wages, Salary, etc.*

How much do you RECEIVE in child support per month?*

If non-applicable, please write ‘0’

How much do you PAY in child support per month?*

If non-applicable, please write ‘0’

How much do you RECEIVE in alimony per month?*

If non-applicable, please write ‘0’

How much do you PAY in alimony per month?*

If non-applicable, please write ‘0’

How much do you pay in religious school or Jewish day school fees per year?*

Please list the name of the Jewish Day School you send your children to*

If non-applicable, please write ‘N/A’

How much do you pay in Synagogue/Temple dues per year?*

Are you receiving Financial Aid from other agencies?*

Are you a member of a country club?*

How much are your member dues per year?*

Do you have any upcoming vacations planned?*

What is the total cost of all vacations scheduled?*

House Payment Type (Mortgage/Rent/Other)*

Do you own a second or vacation home?*

What is the address?*

Street Address City State ZIP Code

What is the total cost of your monthly housing payments?*

What is the total cost of your monthly car payments?*

Please list the type and year of car(s):*

Do you own any recreational vehicles?*

Please list (i.e. RV, Camper, Motorcycle, Boat, etc.) including the fair market value:*

What is the total amount of your credit card debt?*

What is the total amount of your bank loans?*

What is the total amount of your student loans?*

What is the amount you can afford per camper?*

Please list your Jewish Community involvement.*

Please write an explanation of why you feel your family needs scholarship assistance including any non-monetary information that will help us make the best decision for your camper:*

Please upload a copy of your most recent tax return:*

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