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Scholarships

The scholarship fund enables children to experience the Summer of a lifetime. In the current financial climate we expect the demand to be even higher. We appreciate your support!

Scholarship requests:

If you would like a scholarship, the registration process must be completed completely.

The deposit per session is required, however we will not process the deposit until the scholarship procedure is completed.

Please fill out this form as accurately as possible. If you have any questions or difficulties please contact our director, Leah Rosenfeld at 561-649-8468 or Leah@chabadlakeworth.org .

Please note: To protect your privacy, your application will be submitted for review by the committees without any names attached.

Parent #1 Information:

First Name Last Name Employer Job Title City Zip Code Religion Jewish Other Marital Status Please Choose One Married Divorced Widowed Partners Re-married Separated Single (Never Married) Deceased

Parent #2 Information:

First Name Last Name Employer Job Title City Zip Code Religion Jewish Other Marital Status Please Choose One Married Divorced Widowed Partners Re-married Separated Single (Never Married) Deceased

Family Information:
Parent(s) claiming the applicant for tax purposes (2016 Tax returns may be required). Please answer these questions as listed on your tax returns.

Synagogue Affiliation -______________________________ /Unaffiliated

2016 federal tax return: Adjusted gross income 2016 federal tax return:
Filing status Please Choose One Single Married, Joint Married, Separate Head of household Qualifying Widow(er) Total number of exemptions claimed (Line 6D on your 1040 returns) # of Children in family # of Adults in family

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 known events in 2016 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.

Child #1 Information:
Please fill out the following sections separately for each child

Child's Social Security #* First Name Last Name Date of Birth (mm/dd/yyyy) Gender Male Female Grade (Fall 2017) Did you receive a camp scholarship for Summer 2016? Yes No Unsure If yes, please list amount

*If you would prefer not submitting this or any other personal information over our secure servers please call it in to our office 561-649-8468

Child #1 Camp Fees Information:

What can you pay towards camp tuiton? How much can you recieve from friends or family?

If appying for only one child please end here, if applying for multiple children please continue below.

Child #2 Information:

Child's Social Security #* First Name Last Name Date of Birth (mm/dd/yyyy) Gender Male Female Grade (Fall 2017) Did you receive a camp scholarship for Summer 2016? Yes No Unsure If yes, please list amount

*If you would prefer not submitting this or any other personal information over our secure servers you can call in to our office 561-649-8468

Child #2 Camp Fees Information:

What can you pay towards camp tuiton? How much can you recieve from friends or family?

Child #3 Information:

Child's Social Security #* First Name Last Name Date of Birth (mm/dd/yyyy) Gender Male Female Grade (Fall 2017) Did you receive a camp scholarship for Summer 2016? Yes No Unsure If yes, please list amount

*If you would prefer not submitting this or any other personal information over our secure servers you can call in to our office 561-649-8468

Child #3 Camp Fees Information:

What can you pay towards camp tuiton? How much can you recieve from friends or family?

Contribute the the Fund:
Yes! I would like to support the Scholarship Fund. I would like to contribute:
Complete Summer/4 weeks:
$800
1 session:
$200
2 Sessions:
$400
Other:
My Personal Information:

Name:

Email:

Phone:

Please contact me to discuss this contribution

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