Scholarship Application

Financial Information
Have you previously received a scholarship through the Camp Gan Israel Scholarship Fund?

YesNoUnsure
Tax Return Information

Parent(s) claiming the applicant for tax purposes (tax returns are required to be submitted). Please answer these questions as listed on your tax returns.
Adjusted Gross Income*
Line 7 on the Form 1040
Filing Status*
Total number of exemptions claimed*
Line 6D
Number of Adults in Family*
Number of Children in Family*
Non-taxable income (unlisted)*
Please list any non-taxable income not listed on your tax return including rabbinic parsonage or housing allowance
Expected Income for the upcoming year*

Needs
Statement of Need:*
Describe any special expenses or changes in family or economic circumstances over the past year that support your request for financial aid this year. Include any upcoming events that may affect your financial situation in the coming year. Please mention if you are a single parent, first generation émigré, special needs family member, if a parent has lost their job or work hours were reduced. Please indicate the date, the estimated cost of this change, and which parent (one or both parents) was affected. The more details you provide, the better our committee can understand your situation.
Reference

Please provide a rabbinic or personal reference who may be contacted to confirm the information provided above.
Reference Name*

First NameLast Name
Reference Phone Number*

Area CodePhone Number
Request
Amount of full tuition*
Without discounts applied
Amount you can receive from friends, family or other source
If applicable
Please explain source
Amount parents are able to pay towards camp tuition*
Parent participation required, scholarship award cannot cover tuition in full
Total amount requested*
I confirm that all the information contained above is accurate to the best of my knowledge and I understand that if this information is found to be false I may be disqualified from receiving aid and may be required to return any funds received.
Signature*

Clear
Should be Empty:

Parent Information