JSV / APJCC Scholarship Application for External Programs

Scholarship applications for these programs are accepted on a rolling basis and are due 2-4 weeeks prior to the start of the program (depending on program requirements).
Notifications are on a rolling basis and are typically within 2-4 weeks of application submission.

To submit this application, the following documents must be uploaded in the upcoming sections for both the primary and secondary parent / guardian:

Most recent Federal 1040 Tax Return.
Most recent pay or pension stub, current 1099s, W-2's and Social Security award letters.
Program registration form(s) for each program participant.

Please email scholarships@jvalley.org with any questions regarding this form.

Parent / Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Phone Number*

Please enter a valid phone number.

Email Address*

example@example.com

Second Parent / Guardian Name (if applicable)

First NameLast Name

Second Parent / Guardian Phone Number

Please enter a valid phone number.

Second Parent / Guardian Email Address

example@example.com

Are you an APJCC Member?*

YesNo

What type of external program are you requesting a scholarship?*

Teen Trips to IsraelTeen LeadershipJewish Overnight CampOther (Please specify which program in the free text below)

If Other, please specify the program

What is the total program tuition and fees? *

Please provide a dollar ($) amount

What percentage of the total program tuition and fees are you able to contribute?*

Please provide a percentage (%)

Please upload your most recent Federal 1040 Tax returns for both the primary and secondary parent / guardian (where applicable).*

Please upload your most recent pay or pension stub, current 1099s, W-2s, or Social Security award letters for the primary and secondary parent / guardian (where applicable).*

Please upload your registration application form(s) for each program participant.*

Please upload the completed Excel file which you would have downloaded from the Scholarship page (https://www.jvalley.org/scholarship/) .*

Please describe your need, circumstances and how this program will benefit you and your family*

0/500

Are you currently unemployed?*

YesNo

Is Second Parent / Guardian unemployed (if applicable)?

YesNo

Do you or Second Parent / Guardian work at JSV, APJCC Fitness or APJCC Preschool*

YesNo

If you answered yes to the above question, please indicate whether you are Full-Time, Major Part-Time, Minor Part-Time, Temporary or Seasonal.

Please list each of your dependents on a separate line along with your relationship to them and their birthdates and which program you need assistance with.*

	Name of Child	Birthdate	Relationship to Child	Name of Program
Child 1
Child 2
Child 3
Child 4

The following questions pertain to regular monthly expenses.

Expenses that are "unusual" for your family, such as medical expenses, support that is given to family members who are not your legal dependents, etc should be listed under "Other".

Mortgage/Rent*

Please provide a dollar ($) amount

Real Estate Taxes

Please provide a dollar ($) amount

Auto/Other Loans

Please provide a dollar ($) amount

Healthcare Costs

Please provide a dollar ($) amount

Childcare (Non-APJCC Programs)

Please provide a dollar ($) amount

Groceries

Please provide a dollar ($) amount

Utilities

Please provide a dollar ($) amount

Spousal Support

Please provide a dollar ($) amount

Child Support

Please provide a dollar ($) amount

Other School Tuition (Non-APJCC)

Please provide a dollar ($) amount

Other. Please enter in a dollar amount and a description of each expense.

Please list and provide a dollar ($) amount

Total Monthly Expenses*

Please provide a dollar ($) amount

PLEASE NOTE: Parents are responsible for all communication with 3rd party programs and ensuring that JSV/APJCC has the correct payment information and instructions.

Please provide payment information and instructions below. This should include wire or "check made payable to" instructions. *

By clicking "Submit", you agree to the following:

I, the undersigned, understand that the information I provide must be accurate and verifiable. I agree to provide any additional information that JSV/APJCC reasonably requests, and to allow JSV/APJCC to make such reasonable inquiries as it deems necessary in this regard, including without limitation, to banking institutions and credit reporting agencies.

I understand that if any of the foregoing information is inaccurate, JSV/APJCC may take appropriate action at its sole discretion, including without limitation, the withdrawal of any scholarship assistance. In addition, I acknowledge that in the event that my scholarship is withdrawn, I will be expected to pay the balance of the prevailing fee.

Thank you for your submission. We will be in touch once your appplication has been reviewed.

If you have any questions, please contact scholarships@jvalley.org.