YDLV Israeli Scholarship forms

Nechomas Yisrael Scholarship Application
St#
Date of Application*

MonthDayYear
Date
Student Information:
Student Name*
First Name
*
Last Name
Hebrew*
Home Address*
Apt #
City*
State*
Zip*
Phone #*
Emergency #*
Email Address*
example@example.com
Date of Birth*

MonthDayYear
Date
Place of Birth*
City of Origin*
Previous School*
Grade*
Current Yeshiva*
Grade*
Boys: Bris

YesNo
Boys: Pidyon Haben

YesNo
Boys: Tefillin

YesNo
Referred By*
Family Information
Father's Full Name*
Religion*
Father's Mother's Full Name*
Religion*
Father's Date of Birth*

MonthDayYear
Date
Father's Place of Birth*
Date of Arrival in US*

MonthDayYear
Date
City Where You Came From:*
Monthly Gross Income*
Father's Current Employer*
Type of Work*
Business Phone #*
Please enter a valid phone number.
Length of Employment*
Mother's Full Maiden Name*
Religion*
Mother's Mother's Full Name*
Religion*
Mother's Date of Birth*

MonthDayYear
Date
Place of Birth*
Date of Arrival in US*

MonthDayYear
Date
City Where You Came From*
Monthly Gross Income*
Mother's Current Employer*
Type of Work*
Business Phone Number*
Please enter a valid phone number.
Length of Employment*
Any Other Income*
Rent Expense*
Synagogue or Jewish Center Family Attends*
Rabbi*
Do you receive any assistance from:

Please enter amounts for all that apply.
Welfare
NYANA
SSI
Pension
Food Stamps
Child Support
Brother
Name: Age: School:
Brother
Name: Age: School:
Brother Name: Age: School:
Brother Name: Age: School:
Brother Name: Age: School:
Sister Name: Age: School:
Sister Name: Age: School:
Sister Name: Age: School:
Sister Name: Age: School:
Sister Name: Age: School:
By signing below I hereby certify that all of the above information is true and correct:
Signature*

Clear

Chinuch Yehudi Agreement*

The information contained herein is correct to the best of our knowledge and belief.

Learning

Scholarship Learning Requirements:

1. Learn - 1 parent must learn with a partner 30 minutes a week

Learning 8 out of 10 sessions per quarter required.

2. Attend - Both parents must attend 4 Torah classes a year, 1 class per quarter

Lecturer must be your local Chinuch Yehudi Director.

PLEASE NOTE: Failure to fulfill any of the above requirements disqualifies you from receiving a quarterly scholarship. Both parents must attend 4 Torah classes per year, 1 class per quarter (3 months) by an approved Chinuch Yehudi Rabbi.
Personal Learning Partner*

OorahPartners in TorahSpanishAyelet Hashachar
Who is learning with a partner?*

FatherMotherBoth
Classes:*

FatherMother
For unique circumstances where 1 parent cannot attend, please explain:
Participation*

By signing below, I agree to learn with a partner individually (in person or by phone) 30 minutes per week. We (Father and Mother) agree to attend 4 Torah Classes per year.
Father's Signature*

Clear
Mother's Signature*

Clear
Consent*

By signing below, I accept the terms and conditions necessary to recieve a Chinuch Yehudi scholarship.
Father's Signature*

Clear
Mother's Signature*

Clear
https://www.oorah.org/pre-app/tuitionassistance.php
Should be Empty:

Student Information:

Family Information

Do you receive any assistance from: