Israel Scholarship Application 2023-2024

Israel Scholarship Application 2023-2024

Deadline: July 15, 2023
Name of Applicant(s)*
Date of Birth MM/DD/YY*
Age as of July 1*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Mother’s daytime phone: *
Please enter a valid phone number.
Father’s daytime phone: *
Please enter a valid phone number.
Mother’s E-Mail Address: *
example@example.com
Father's E-Mail Address: *
example@example.com
Is your family affiliated with a synagogue, youth group or other Jewish community group?*

YesNo
If yes, which one(s)?
Are you involved with any Jewish Community activities or organizations (such as a youth group?) *
If yes, please explain your position or involvement within these groups.*
When do you plan to travel to Israel? *
Which group or program will you be traveling with?*
Describe the basic purpose/ itinerary of your trip (leisure, volunteer work, study, etc.)*
What is the total cost of your trip? *
Have you applied for any additional scholarships, stipends or other monies to help finance this trip? (i.e., other scholarships, family assistance, employer assistance, etc.)*
What is the amount you are requesting from the Federation? *
Upon your return, you will be required to either write an essay for our local newspaper, or come to speak to a group of either children or adults sharing your Israeli experiences. Please acknowledge that you have read this statement and agree to comply by signing your initials here

Clear
In the space below, tell us why you feel you should be considered for this award. You may also include any other information you would like to share with the committee.*
Signature

Clear
Date*

MonthDayYear
Date
Confidential Financial Information
Family Name*
Father’s Name:*

First NameLast Name
Father's Occupation*
Father’s Employer’s Name*
Father’s Employer’s Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother’s Name:*

First NameLast Name
Mother’s Occupation*
Mother’s Employer’s Name*
Mother’s Employer’s Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
All sources of Family Income:*

Below $15,000$15,001-$25,000$25,001-$40,000$40,001-$60,000$60,001-$75,000$75,000 - $100,000$100,000 - $125,000$125,000+
Do you have additional resources not reflected on your IRS Form 1040 or 1040A? (i.e. Parsonage, family assistance, other stipends, etc.)*

YesNo
Please provide a 1040 and/or 1040A *

Cancelof
If yes, how much?*
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 claim you wish considered:*
By signing this form, I declare that all information submitted is accurate and verifiable.
Mother's Signature

Clear
Date*

MonthDayYear
Date
Father's Signature

Clear
Date*

MonthDayYear
Date
Should be Empty: