Jewish Federation Financial Assistance Application Form

Camp Financial Assistance Application '24 Funding Request Form

Please submit completed application by Feb 25th, 2024. Only one form required per family.
Name of Summer Day Camp for which you are requesting a scholarship: Ashreinu

Religion in which child/ren is/are being raised: Jewish
Number of children/dependents in household:*
Child's/Children's Name(s) that you are requesting a scholarship for:*
Parent 1 Name*
Parent 1 Phone Number (Home)*
Parent 1 Phone Number (Cell)*
Parent 1 Address*
City*
State*
Zip*
Parent 1 Email*
Parent 1 Employer*
Number of Years Employed At This Place*
Work Telephone Number*
Annual Employment Income $*
Check If Unemployed
Other Sources of Income (Clergy housing allowance/parsonage, gov't assistance, etc) -- Source 1 $
Other Sources of Income (Clergy housing allowance/parsonage, gov't assistance, etc) -- Source 2 $
Ongoing Obligations -- Rent/Mortgage Amount $*
Ongoing Obligations -- Other (specify) $
Please describe any unusual expenses and amounts:
Comments and any other information you would like us to consider:
Parent 2 Name
Parent 2 Phone Number (Home)
Parent 2 Phone Number (Cell)
Parent 2 Address
City
State
Zip
Parent 2 Email
Parent 2 Employer
Number of Years Employed At This Place
Work Telephone Number
Annual Employment Income $
Check If Unemployed
Other Sources of Income (Clergy housing allowance/parsonage, gov't assistance, etc) -- Source 1 $
Other Sources of Income (Clergy housing allowance/parsonage, gov't assistance, etc) -- Source 2 $
Ongoing Obligations -- Rent/Mortgage Amount $
Ongoing Obligations -- Other (specify) $
If parents are divorced, who is the custodial parent?
Check if joint custody
Is this child or other children in the family receiving other fee adjustments? (e.g. public assistance, day care, food stamps, scholarships, vouchers)
The following forms are required of all applicants for financial assistance.*

Completed Form 1040 of my federal tax return for the most recent tax year.OR Social Security award letter for the most recent tax year.
Upload tax information here or email to ashreinujfscho@gmail.com
Please explain any extenuating circumstances:
I certify the accuracy of the information provided on this application for financial assistance and understand that any monies may be revoked in the event of misrepresentation.*

Clear
Will your child be eligible for government day care assistance?*

YesNo
Please note, children may only be eligible for a Jewish Federation Scholarship if they are not receiving Government Daycare Funding.
Should be Empty:

Camp Financial Assistance Application '24 Funding Request Form