CHS Registration - Scholarship Application

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Father/Guardian Information
Name:*
First Name Last Name
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Cell phone:*

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Employer:
Years there:
Mother/Guardian Information
Name:*
First Name Last Name
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Cell phone:*

Area Code Phone Number
Employer:
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Scholarship Information
This information is used to help determine eligibility. Applications are held in the strictest confidence.
Explain why you feel you need scholarship assistance. List any unusual circumstances that the committee should know about.*
I would like to apply for:*

Partial scholarship of $600 per studentPartial scholarship of $500 per studentPartial scholarship of $400 per studentPartial scholarship of $300 per studentPartial scholarship of $200 per studentNone. I would like to pay by monthly installmentsFull Scholarship $700 (does not include $100 Registration Fee)
I can pay in monthly installments of:
Chabad Jewish Community Center will contact you regarding this application.
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Chabad Jewish Community Center will contact you regarding this application.