Scholarship Application

Family's last name:*

Student Information

Child #1:*

First Name Last Name

Child #2:

First Name Last Name

Child #3:

First Name Last Name

Home address:*

Street Address
Subdivision
City	State / Province
Postal / Zip Code	Country

Home phone:

Area Code Phone Number

Father/Guardian Information

Name:*

First Name Last Name

E-mail:*

Cell phone:*

Area Code Phone Number

Employer:

Years there:

Mother/Guardian Information

Name:*

First Name Last Name

E-mail:*

Cell phone:*

Area Code Phone Number

Employer:

Years there:

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:*

Full tuition scholarship of $300 per student ($50 registration fee not included)Partial scholarship of $50 per studentPartial scholarship of $100 per studentPartial scholarship of $175 per studentPartial scholarship of $250 per studentNone. I would like to pay by monthly installments

I would like to apply for *

Week 1Week 2Week 1 & 2

I can pay in monthly installments of:

Chabad Jewish Community Center will contact you regarding this application.

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