To request a a scholarship beyond our tier price system please fill out this form. Upon approval of your scholarship we will email you a unique code for you to use with our camp registration system that will allow you to register at the agreed upon rate. Parent #1 Information Full Name First Name Last Name Employer Job Title City of Residence Religion JewishOther Synagogue Affiliation Marital Status Parent #2 Information Full Name First Name Last Name Employer Job Title City of Residence Religion JewishOther Synagogue Affiliation Marital Status Child #1 Information Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade (Fall 2018) Did you receive a camp scholarship for 2017? YesNoUnsure If yes, please list amount Child #2 Information Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade (Fall 2018) Did you receive a camp scholarship for 2017? YesNoUnsure If yes, please list amount Child #3 Information Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade (Fall 2018) Did you receive a camp scholarship for 2017? YesNoUnsure If yes, please list amount Financial InformationParent(s) claiming the applicant for tax purposes (2018 Tax returns are required). Please answer these questions as listed on your tax returns. 2016 federal tax return: Adjusted gross income 2016 federal tax return: Filing status Total number of exemptions claimed (Line 6D on your 1040 returns) # of Children in family # of Adults in family Statement of NeedDescribe any special expenses or changes in family or economic circumstances over the past year that support your request for financial aid this year. Include known events in 2018 that will impact your family. (new child, bar mitzvah, etc). Please mention if you are a single parent, first generation émigré, special needs family member, or have multiple children attending. OR 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 effected. The more details you provide, the better our committee can understand your situation. Text here 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 Date Email Should be Empty: Submit This page uses TLS encryption to keep your data secure.
Westy Gan Izzy 
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This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
