Day Camp Campership Application

Day Camp Campership Application

February 15, 2025 to April 30, 2025
Jewish camp programs support Jewish identity and continuity.

The Jewish Federation of Western CT is pleased to award day camperships for children to attend Jewish summer day camp.

The scholarships are made available through the generosity of several funds of the Federation’s Endowment, including the Joel Varnick Overnight Campership Fund, the Sophie, Joseph and Mark Brinker Fund, the William Finkelstein Fund for Needy Jews, the Charlotte and David Walzer Camping Fund and Waterbury Hebrew Ladies Aid Fund.

The completed campership application must be submitted on or before April 30, 2025
First time camper? If no, list the camp names and dates the applicant attended*

YesNo
In order to be considered for an award, the family must be current members of the Federation with a minimum of $36 to the current annual campaign and agree by initialing the following:*

We are current members of the Federation and have made the minimum $36 to the current annual campaignDemonstrate a commitment to the Jewish Community and to Jewish learning.Resident in the Federation’s service area (see our website at www.jfed.net).Child must be between the ages of 6 and 16 on July 1st of the current year.One application should include all children applying for that camp.Included in your application a copy of the camp invoice showing your paid registration fee and/or deposit for your child and the camp's billing address.Included in your application a copy of pages 1 & 2 and supplemental pages if required to list all children in the household of your 2024 or later income tax return - PLEASE BLACK OUT ALL SOCIAL SECURITY NUMBERSYour application will not be considered unless all information is completed and submitted by April 30, 2025.Past awards do not guarantee future awards. Award values change each year with the change of available dollars for camping scholarships.Attending a nonprofit, Jewish day camp, preferably one listed on One Happy Camper: www.jewishcamp.org/one-happy-camper/find-a-camp
List the camp names and dates the applicant attended here. *
Please list all children attending this Day Camp.
First Name* Last Name* Date* Dates attending*
MonthDayYear
DOB
First Name Last Name Date Dates attending
MonthDayYear
DOB
First Name Last Name Date Dates attending
MonthDayYear
DOB
Name and Address of Day Camp
First Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount you are requesting from the Jewish Federation Endowment:
Please enter dollar amount below: *
Parents/Guardian’s Information
Parent/Guardian 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is the applicant involved with any Jewish Community activities or organizations (such as a youth group?) If yes, please explain.*
Has the applicant received any formal Jewish education? If yes, please describe:*
Dates of when is the applicant is planning to attend camp (first date through last date)?
Date* Date*
What will be the total camp cost for your family, less scholarships, discounts or gifts toward camp fees, you receive or will receive? *
Will you be receiving financial assistance for camp from any source other than the Federation Endowment? (i.e. Camp scholarship, family assistance, employer assistance, or other source) Yes or No - If yes, how much assistance will you receive in total?*
Confidential Financial Information

Please note that all information on this sheet will be held in the strictest confidence.
Family Name First Name*
Parent/Guardian 1*

First NameLast Name
Occupation First Name*
Employers Name First Name*
Employers Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Adjusted Gross Income as stated in your 2024 tax return*
Copy of 2024 tax return must be uploaded for verification
Number of members in your household as listed in your 2024 tax return*
Do you have additional resources not reflected on the IRS Form 1040 or 1040A? (i.e. Parsonage, family assistance, other stipends, etc.)*

YesNo
If yes, how much assistance will you receive in total?*
A copy of page 1 & 2 from your last year’s IRS Form 1040 or 1040A must be submitted in order to be considered.

See Instructions.

It is important to provide any additional information you would like us to consider, which may not be reflected in your financials. Use additional space if needed. Please provide evidence of the circumstances you wish to be considered:
By signing this agreement with your electronic signature, you declare that all information submitted is accurate and verifiable.
Parent/Guardian 1 Signature:*

Clear
Date*

MonthDayYear
Date
Parent/Guardian 2 Signature:*

Clear
Date*

MonthDayYear
Date
Upload your most recent tax forms*

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Upload your camp invoice*

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