Parent Information
Parent 1
Parent 1 Name
*
First Name
Last Name
Parent 1 Phone Number
*
-
Area Code
Phone Number
Parent 1 Email
*
example@example.com
Parent 1 Marital Status
*
Please Select
Married
Divorced
Separated
Single
Deceased
Other
Household Status
*
Two Parent Household
Separate Households
Single Parent
Parent 1 Employer
*
Parent 1 Job Title
*
Parent 2
Parent 2 Name
*
First Name
Last Name
Parent 2 Email
*
example@example.com
Parent 2 Marital Status
*
Please Select
Married
Divorced
Separated
Single
Deceased
Other
Parent 2 Employer
*
Parent 2 Job Title
*
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Children Information
Child 1
Child 1 Name
*
First Name
Last Name
Child 1 Date of Birth
*
-
Month
-
Day
Year
Date
Child 1 Current Age
*
Please Select
2
3
4
5
Child 1 Registration
I am applying for
*
Preschool - Current Year
Preschool - Upcoming Year
Summer Program
Other
Preschool Scholarship
Preschool: Hours Requested
*
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Preschool: Hours Requested
*
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Preschool: Days Requested
*
5 Day Option (M-F)
3 Day Option (M,W,F)
2 Day Option (Tu, Th)
Preschool: Days Requested
*
2 Days
3 Days
5 Days
Summer Scholarship
Summer: Weeks Requested
*
Week 1 (6/22-6/26)
Week 2 (6/29-7/2)
Week 3 (7/6-7/10)
Week 4 (7/13-7/17)
Week 5 (7/20-7/24)
Week 6 (7/27-7/31)
Week 7 (8/3-8/7)
Summer: Hours Requested
*
Full Day (9:00 am - 3:30 PM)
Early Care (8:30 am - 3:30 PM
After Care (9:00 am - 5:00 PM)
Early & After Care (8:30 am - 5:00 PM)
Add a Second Child
Child 2 Name
First Name
Last Name
Child 2 Date of Birth
-
Month
-
Day
Year
Date
Child 2 Current Age
2
3
4
5
Child 2 Registration
I am applying for
Preschool - Current Year
Preschool - Upcoming Year
Summer Program
Other
Preschool Scholarship
Preschool: Hours Requested
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Preschool: Days Requested
5 Day Option (M-F)
3 Day Option (M,W,F)
2 Day Option (Tu, Th)
Summer Scholarship
Summer: Weeks Requested
Week 1 (6/17-6/21)
Week 2 (6/24-6/28)
Week 3 (7/1-7/5)
Week 4 (7/8-7/12)
Week 5 (7/15-7/19)
Week 6 (7/22-7/26)
Week 7 (7/29-8/2)
Summer: Weeks Requested
*
Week 1 (6/22-6/26)
Week 2 (6/29-7/2)
Week 3 (7/6-7/10)
Week 4 (7/13-7/17)
Week 5 (7/20-7/24)
Week 6 (7/27-7/31)
Week 7 (8/3-8/7)
Summer: Hours Requested
Full Day (9:00 am - 3:30 PM)
Early Care (8:30 am - 3:30 PM
After Care (9:00 am - 5:00 PM)
Early & After Care (8:30 am - 5:00 PM)
Child 1 Registration: Days Requested
*
2 Days
3 Days
5 Days
Child 1 Registration: Hours Requested
*
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Child 2 Registration
2 Days
3 Days
5 Days
Core Program (12:30)
Extended Day (2:30)
Aftercare (4:00)
Add a Third Child
Child 3 Name
First Name
Last Name
Child 3 Date of Birth
-
Month
-
Day
Year
Date
Child 3 Current Age
2
3
4
5
Child 3 Registration
I am applying for
Preschool - Current Year
Preschool - Upcoming Year
Summer Program
Other
Preschool Scholarship
Preschool: Hours Requested
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Preschool: Days Requested
5 Day Option (M-F)
3 Day Option (M,W,F)
2 Day Option (Tu, Th)
Summer Scholarship
Summer: Weeks Requested
Week 1 (6/17-6/21)
Week 2 (6/24-6/28)
Week 3 (7/1-7/5)
Week 4 (7/8-7/12)
Week 5 (7/15-7/19)
Week 6 (7/22-7/26)
Week 7 (7/29-8/2)
Summer: Weeks Requested
*
Week 1 (6/22-6/26)
Week 2 (6/29-7/2)
Week 3 (7/6-7/10)
Week 4 (7/13-7/17)
Week 5 (7/20-7/24)
Week 6 (7/27-7/31)
Week 7 (8/3-8/7)
Summer: Hours Requested
Full Day (9:00 am - 3:30 PM)
Early Care (8:30 am - 3:30 PM
After Care (9:00 am - 5:00 PM)
Early & After Care (8:30 am - 5:00 PM)
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Financial Information
Have you previously received a scholarship through Gan Torah Scholarship Fund?
Yes
No
Unsure
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 37 on the Form 1040, Line 21 on the Form 1040A, Line 4 on the Form 1040EZ
Filing Status
*
Please Select
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow/Widower with Dependent Child
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
*
Second Parent Financial Information
Basic Financial Information for second parent is required (Write "NA" for any unknown information)
Second Parent's Financial Responsibility
*
Parent 2 Adjusted Gross Income
*
Parent 2 Non-taxable income (unlisted)
*
Please list any non-taxable income not listed on your tax return including rabbinic parsonage or housing allowance
Parent 2 Expected Income for the upcoming year
*
Request
Amount of full tuition
*
Without discounts applied
Amount you can receive from friends, family or other source
If applicable
Please explain source
If applicable
Amount parents are able to pay towards tuition
*
Total amount requested
*
Summer Registration
I am applying for a scholarship for the summer
I am NOT applying for a scholarship for the summer
Summer Dates Registration
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Full Summer
Summer Times Registration
Core Program (12:00)
Full Day (3:00)
Extended Day (5:00)
Amount of full tuition
Without discounts applied
Amount you can receive from friends, family or other source
If applicable
Amount parents are able to pay towards tuition
Total amount requested
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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 Name
Last Name
Reference Phone Number
*
-
Area Code
Phone Number
Confirmation
*
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
*
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