LPS/TCA Financial Aid Form 23/24

Financial Aid Form

Summer Camp 2025

School 2025/2026

Hebrew School 2025/2026

Please select:

LPS/TCACamp Gan IsraelSchool and CampHebrew School

Personal Information

Family Last Name*

Parent 1*

Parent 2*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number*

Area CodePhone Number

Parent 1 E-mail*

example@example.com

Parent 1 Cell Phone*

Area CodePhone Number

Parent 2 E-mail*

example@example.com

Parent 2 Cell Phone*

Area CodePhone Number

Congregation Affiliation*

Names of children attending LPS/TCA/Camp Gan Israel

Child's Name*

Grade Entering in Fall 2025*

Child's Name

Grade Entering in Fall 2025

Child's Name

Grade Entering in Fall 2025

Child's Name

Grade Entering in Fall 2025

Child's Name

Grade Entering in Fall 2025

Please check off any additional programs you are signing up for, for the 2025/2026 year. * (While financial aid does not apply to the programs below, it is helpful to know what additional programming is necessary for your family.)*

Parent 1 Occupation*

Parent 1 Employer's Name*

Parent 1 Work Phone Number*

Parent 1 Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent 2 Occupation*

Parent 2 Employer's Name*

Parent 2 Work Phone Number*

Parent 2 Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List children other than those listed above and the schools they are attending in 2025-2026:

Child's Name

School

Child's Name

School

Child's Name

School

* Scholarships are not available for our additional programs. However, it is important that we have a full understanding of the scope of your needs before we can determine your financial arrangement.

Financial Data

List all schools from which you received financial assistance (including Lubavitch on the Palisades). Please include your bill showing the amount of scholarship granted from each school.

School Name 1*

Scholarship given 1*

Amount of tuition paid 1*

School Name 2

Scholarship given 2

Amount of tuition paid 2

School Name 3

Scholarship given 3

Amount of tuition paid 3

Parent 1 gross income 2024 $*

Parent 2 gross income 2024 $*

Parent 1 income anticipated 2025 $*

Parent 2 income anticipated 2025 $*

Total Assets including but not limited to real estate, stocks, savings accounts, etc. $*

Are there any other benefits (childcare, savings plan, insurance, matching funds, etc.) provided through your employer? Please describe

Do you lease or own your vehicles?

Vehicle 1*

OwnLeaseNo vehicle

Vehicle 1 Make & Model*

Vehicle 1 Year*

Vehicle 1 Monthly Cost*

Vehicle 2

OwnLease

Vehicle 2 Make & Model

Vehicle 2 Year

Vehicle 2 Monthly Cost

Do you have full or part time domestic help?*

Part-timeFull-timeNone

Do you have childcare at home?*

Part-timeFull-timeNone

Childcare weekly cost*

Which camp(s) did your child(ren) attend last summer?

Camp 1*

Camp 1 Cost*

Camp 2

Camp 2 Cost

Do you own your home?*

YesNo

Year purchased

Purchase price

Monthly mortgage or Rental payment*

Real estate taxes per year

Do you have an outstanding balance in this year’s tuition?*

YesNo

Amount $*

Dates amount will be paid*

Scholarship amount requesting $*

Loan amount requesting $

Total amount and payment schedule you feel you can afford for tuition*

Are you willing to donate your services as a volunteer? Please describe the areas of your expertise*

Is there any other pertinent information that would affect your ability to pay full tuition? *

Please list two references that we may contact regarding your request:

Reference 1 Name *

Reference 1 Relationship*

Reference 1 Phone *

Reference 2 Name *

Reference 2 Relationship*

Reference 2 Phone*

We declare that the information in this application to the best of our knowledge
is accurate and true.

Parent's Name 1*

Parent's Name 2*

School Financial Aid Parent Checklist

PLEASE ENSURE THAT YOU HAVE INCLUDED ALL OF THE FOLLOWING PAPERWORK

WITH YOUR COMPLETED APPLICATION AND KEEP THIS PAGE ONLY FOR YOUR RECORDS

All of the items below must be included in order for your request to be considered

____ 1. Completed Financial Request Form (completed in its entirety)

____ 2. 2024 Federal Tax Return including all schedules and documentation.

____ 3. 2023 Federal Tax Return including all schedules and documentation.

____ 4. OPTIONAL: A personal statement explaining your personal circumstances

that are not reflected in your application form.

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