Teen Israel Experience Loan/Grant Form

The Jewish Federation of Greater Vancouver and The Hebrew Free Loan Association (HFLA) have partnered to make educational travel to Israel more accessible for teens from British Columbia.

In completing this form, you are submitting a joint application for a Federation Israel experience scholarship of up to $2,500 and interest-free trip financing from HFLA of of up to $5,000. Both agencies will receive a copy of this form.

Program Participant's Name (ie: the camper/student): *

First Name Last Name

Program Participant's Birthdate: *

Date

Program Participant's Current Grade: *

Grade 9 Grade 10 Grade 11 Grade 12

Which youth organization if offering this program? *

BBYO Canadian Young Judaea Habonim Dror March of the Living NCSY NFTY USY Other

Would you like us to send your financial information to Canadian Young Judaea so that you can be considered for a scholarship with them as well? *

Yes No

Would you like us to send your financial information to Beth Israel so that you can be considered for a scholarship with them as well? *

Yes No

What is the specific name of the program your child is participating in: *

What is the program mailing address? *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is the program's email address: *

example@example.com

What is the program start date? *

Date

What is the program end date? *

Date

What is the total cost of the program in Canadian Dollars? *

What is the amount of Federation Scholarship you would like to be considered for (up to $2,500)? *

What is the amount of HFLA financing would like to be considered for (up to $5,000)? *

Have you applied for any other grants/scholarships for this Israel experience? *

Yes No

Please provide details about the amount you have applied for and if it has been awarded yet.

Have you ever been to Israel on a structured youth trip with your school, camp our youth group? *

Yes No

Please provide details including the year of the trip, the organizer (ie: the school or youth group) and indicate if you have previously received a Federation scholarship for this):

Please upload a personal statement from your child on what they hope to gain from this Israel experience, their goals for the future and anything else that may be relevant to this application. *

function SvgDhtupload(props) { return /* @__PURE__ */ react.createElement("svg", dhtupload_svg_extends({ width: 54, height: 47, xmlns: "http://www.w3.org/2000/svg" }, props), dhtupload_svg_path || (dhtupload_svg_path = /* @__PURE__ */ react.createElement("path", { d: "M40.213 10.172c1.897.21 3.68.738 5.35 1.58a15.748 15.748 0 014.374 3.242 15.065 15.065 0 012.951 4.533c.72 1.704 1.08 3.522 1.08 5.455 0 1.827-.28 3.654-.843 5.48-.562 1.828-1.379 3.47-2.45 4.929A13.39 13.39 0 0146.669 39c-1.599.948-3.452 1.458-5.56 1.528H37.26a1.62 1.62 0 01-1.185-.5 1.62 1.62 0 01-.501-1.186c0-.457.167-.852.5-1.186.334-.334.73-.5 1.186-.5h3.848c1.44 0 2.75-.37 3.926-1.108a10.851 10.851 0 003.03-2.846 13.53 13.53 0 001.95-3.9 14.23 14.23 0 00.686-4.321c0-1.582-.316-3.066-.949-4.454a11.623 11.623 0 00-2.582-3.636 12.857 12.857 0 00-3.742-2.478 11.054 11.054 0 00-4.48-.922l-1.212-.053-.37-1.159c-.878-2.81-2.292-4.998-4.242-6.562-1.95-1.563-4.594-2.345-7.932-2.345-2.108 0-4.005.36-5.692 1.08-1.686.72-3.136 1.722-4.348 3.005-1.212 1.282-2.143 2.81-2.793 4.585-.65 1.774-.975 3.68-.975 5.718h.053l.105 1.581-1.528.264c-1.863.316-3.444 1.317-4.744 3.004-1.3 1.686-1.95 3.584-1.95 5.692 0 2.39.8 4.462 2.398 6.219 1.599 1.757 3.488 2.635 5.666 2.635h4.849c.492 0 .896.167 1.212.5.316.335.474.73.474 1.187 0 .456-.158.852-.474 1.185-.316.334-.72.501-1.212.501h-4.849a10.08 10.08 0 01-4.374-.975 11.673 11.673 0 01-3.61-2.661 13.173 13.173 0 01-2.478-3.9A12.073 12.073 0 010 28.301c0-2.706.755-5.148 2.266-7.326 1.511-2.178 3.444-3.636 5.798-4.374.14-2.354.658-4.542 1.554-6.562.896-2.02 2.091-3.777 3.584-5.27 1.494-1.494 3.25-2.662 5.27-3.505C20.493.422 22.733 0 25.193 0c1.898 0 3.637.237 5.218.711 1.581.475 3.004 1.151 4.269 2.03a13.518 13.518 0 013.268 3.215 18.628 18.628 0 012.266 4.216zm-11.964 13.44l6.22 6.85c.245.247.368.537.368.87 0 .334-.123.642-.369.923l-.421.263c-.211.246-.484.343-.817.29a1.544 1.544 0 01-.87-.448l-3.69-4.11v16.97c0 .492-.166.896-.5 1.212-.334.316-.729.474-1.186.474-.492 0-.896-.158-1.212-.474-.316-.316-.474-.72-.474-1.212V28.25l-3.584 4.005a1.544 1.544 0 01-.87.448.959.959 0 01-.87-.29l-.42-.264c-.247-.28-.37-.588-.37-.922 0-.334.123-.624.37-.87l6.113-6.746v-.052l.421-.422a.804.804 0 01.396-.29c.158-.053.307-.079.448-.079.175 0 .333.026.474.079.14.053.281.15.422.29l.421.422v.052z", fill: "none" }))); }

Who does the participant (child) live with? *

Parent 1's Name: *

First Name Last Name

Parent 1's Email Address: *

example@example.com

Parent 1's Cell Phone Number: *

Please enter a valid phone number.

Parent 1's Date of Birth: *

Parent 1's citizenship status: *

Is Parent 1 Jewish? *

Yes No

Parent 2's Name: *

First Name Last Name

Parent 2's Email Address: *

example@example.com

Parent 2's Phone Number: *

Please enter a valid phone number.

Parent 2's Date of Birth: *

Parent 2's citizenship status: *

Is Parent 2 Jewish? *

Yes No

Does your co-parent have financial responsibilities towards the participant. *

No, they are not in the participant's life Yes, they contribute financially and will submit their own copy of this form. Other

Does your co-parent have financial responsibilities towards the participant. *

No Yes, they contribute financially and will submit their own copy of this form. Other

Please list all of your financially dependent children (including the participant you are applying for this grant/loan for) *

	Name	Age
Child 1
Child 2
Child 3
Child 4
Child 5

Home Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Do you own or rent this home *

What year was this home purchased? *

What was the original purchase price of this home? *

What is the current value of this home? *

How much is owed on this home? *

Total equity in this home: *

Please complete the following non-residential ASSET chart for both yourself and your spouse/ partner. If a question is not applicable to you, please input the number "0". *

	Applicant (Parent 1)	Spouse
Bank Balance
RRSP's
GIC's
Other Investments
Total

Total combined non-residential assets: *

Please complete the following non-residential LIABILITY chart for both yourself and your spouse/partner. If a question is not applicable to you, please input the number "0". *

	Applicant (Parent 1)	Spouse
Personal Loans
Student Loans
Outstanding Line of Credit
Credit Card Debt
Other Debts
Total

Total combined non-residential liabilities: *

Have you ever had a loan or financial obligation sent to collections? *

Yes No

Have you ever declared bankruptcy? *

Yes No

Total Residential + Non Residential Assets *

Total Residential + Non Residential Liabilities *

Net Worth *

Please complete the following Employment chart for both yourself and your spouse/partner. If a question is not applicable, please input the word "N/A". *

	Applicant (Parent 1)	Spouse
Job Title
Name of employer
Years at this job
Gross Annual Income

Please complete the following MONTHLY income chart for both yourself and your spouse/partner. If a question is not applicable to you, please input the number "0" *

	Applicant (Parent 1)	Spouse
Net Monthly employment income*
Monthly Canada Child Benefit (CCB) Income
Monthly Income from government programs (E.I., CRB, Income Assistance, PWD Assistance etc)
Monthly Income from pensions, Old Age Security (OAS) and Guaranteed Income Supplement (GIS)
Monthly Income from any other sources
Total

*NET income is the amount you earn after tax and deductions. It is the amount that you receive in your bank account or on your pay cheque.

Please attach a copy of both yours and your spouse's 2020 Notice of Assessments. *

function SvgDhtupload(props) { return /* @__PURE__ */ react.createElement("svg", dhtupload_svg_extends({ width: 54, height: 47, xmlns: "http://www.w3.org/2000/svg" }, props), dhtupload_svg_path || (dhtupload_svg_path = /* @__PURE__ */ react.createElement("path", { d: "M40.213 10.172c1.897.21 3.68.738 5.35 1.58a15.748 15.748 0 014.374 3.242 15.065 15.065 0 012.951 4.533c.72 1.704 1.08 3.522 1.08 5.455 0 1.827-.28 3.654-.843 5.48-.562 1.828-1.379 3.47-2.45 4.929A13.39 13.39 0 0146.669 39c-1.599.948-3.452 1.458-5.56 1.528H37.26a1.62 1.62 0 01-1.185-.5 1.62 1.62 0 01-.501-1.186c0-.457.167-.852.5-1.186.334-.334.73-.5 1.186-.5h3.848c1.44 0 2.75-.37 3.926-1.108a10.851 10.851 0 003.03-2.846 13.53 13.53 0 001.95-3.9 14.23 14.23 0 00.686-4.321c0-1.582-.316-3.066-.949-4.454a11.623 11.623 0 00-2.582-3.636 12.857 12.857 0 00-3.742-2.478 11.054 11.054 0 00-4.48-.922l-1.212-.053-.37-1.159c-.878-2.81-2.292-4.998-4.242-6.562-1.95-1.563-4.594-2.345-7.932-2.345-2.108 0-4.005.36-5.692 1.08-1.686.72-3.136 1.722-4.348 3.005-1.212 1.282-2.143 2.81-2.793 4.585-.65 1.774-.975 3.68-.975 5.718h.053l.105 1.581-1.528.264c-1.863.316-3.444 1.317-4.744 3.004-1.3 1.686-1.95 3.584-1.95 5.692 0 2.39.8 4.462 2.398 6.219 1.599 1.757 3.488 2.635 5.666 2.635h4.849c.492 0 .896.167 1.212.5.316.335.474.73.474 1.187 0 .456-.158.852-.474 1.185-.316.334-.72.501-1.212.501h-4.849a10.08 10.08 0 01-4.374-.975 11.673 11.673 0 01-3.61-2.661 13.173 13.173 0 01-2.478-3.9A12.073 12.073 0 010 28.301c0-2.706.755-5.148 2.266-7.326 1.511-2.178 3.444-3.636 5.798-4.374.14-2.354.658-4.542 1.554-6.562.896-2.02 2.091-3.777 3.584-5.27 1.494-1.494 3.25-2.662 5.27-3.505C20.493.422 22.733 0 25.193 0c1.898 0 3.637.237 5.218.711 1.581.475 3.004 1.151 4.269 2.03a13.518 13.518 0 013.268 3.215 18.628 18.628 0 012.266 4.216zm-11.964 13.44l6.22 6.85c.245.247.368.537.368.87 0 .334-.123.642-.369.923l-.421.263c-.211.246-.484.343-.817.29a1.544 1.544 0 01-.87-.448l-3.69-4.11v16.97c0 .492-.166.896-.5 1.212-.334.316-.729.474-1.186.474-.492 0-.896-.158-1.212-.474-.316-.316-.474-.72-.474-1.212V28.25l-3.584 4.005a1.544 1.544 0 01-.87.448.959.959 0 01-.87-.29l-.42-.264c-.247-.28-.37-.588-.37-.922 0-.334.123-.624.37-.87l6.113-6.746v-.052l.421-.422a.804.804 0 01.396-.29c.158-.053.307-.079.448-.079.175 0 .333.026.474.079.14.053.281.15.422.29l.421.422v.052z", fill: "none" }))); }

Total combined monthly net income: *

Please complete the following MONTHLY expense chart for your family. If a question is not applicable to you, please input the number "0" *

	Monthly Cost
Monthly Rent or Mortgage Payment
Monthly Property Tax Payment
Monthly Strata/Maintenance Payment
Monthly Car Payment(s)
Monthly Cost of Auto Insurance
Monthly Cost of Car Gas
Monthly Cost of Public Transportation
Monthly Cost of Extended Medical Coverage
Monthly Cost of Utilities (heat & hydro)
Monthly Cost of TV, Phone(s) and Internet
Monthly Cost of Food
Monthly Cost of Clothing & Personal Care Items
Monthly Cost of Childcare or Day School Tuition
Monthly Cost of University Tuition
Monthly Costs of Loan/Debt Payments
Monthly Cost of Other Expenses
Total

Please complete the following Automobile Chart for both you and your spouse: *

	Applicant (Parent 1)	Spouse
Car Make
Car Model
Year
Amount of monthly loan/lease payment

Total Combined Monthly Expenses *

Monthly Income - Monthly Expenses = *

I,First Name Last Name, declare that the information provided in this application is true and correct.

I acknowledge and agree that the personal information collected from me may be disclosed to the employees and volunteers involved in the grant and loan decision process, to persons retained by HFLA to administer the loan and to the other persons deemed necessary by HFLA for the provision or enforcement of the loan.

I also agree that both Federation and HFLA can communicate with the trip organizer about all aspects of my application. I understand that any grant/loan will be sent directly to the trip organizer.

Signature

Clear

Date *

Date

Teen Israel Experience Loan/Grant Application Form

Parent Information

Family Questions

Housing Questions

Financial Questions

Employment Questions

Monthly Expense Questions

Acknowledgment and Declaration