Student Information

Funding Information

Parent/Guardian Information ~ Parent #1

Parent/Guardian Information ~ Parent #2

Composition of Family Household

Parents' Financial Information

Income (both taxable and non-taxable)

Gross salary and wages from W-2 ~ Parent #1

Gross salary and wages from W-2 ~ Parent #2

Dividend or interest income ~ Parent #1

Dividend or interest income ~ Parent #2

Other income (rents, business, royalties, trusts, unemployment compensation, Social Security benefits, scholarships) ~ Parent #1

Other income (rents, business, royalties, trusts, unemployment compensation, Social Security benefits, scholarships) ~ Parent #2

Parsonage (do not include in salary above) ~ Parent #1

Parsonage (do not include in salary above) ~ Parent #2

Annual Alimony ~ Parent #1

Annual Alimony ~ Parent #2

Child Support received for all minor children annually ~ Parent #1

Child Support received for all minor children annually ~ Parent #2

Public aid, food stamps, SSI (disability, death benefits) ~ Parent #1

Public aid, food stamps, SSI (disability, death benefits) ~ Parent #2

Applicant's Profile

To be completed by teen applicant, not by parent.

Current Employment:

Summer Employment 2021*

Jewish Involvement

Is your application complete? Please do not submit applications that have not been completed. Your completed application must include:

  1. This form filled out completely and signed by both the parent/guardian and the applicant.
  2. The first page of the most recent 1040 for the household. 
  3. Written statement by the applicant on why this trip is important to them. 

** Applications with incomplete or missing forms will not be submitted to our committee for consideration.**



I attest to this application being true, and complete to the best of my knowledge and I authorize the Federation to check its validity. I understand this is only an application for a scholarship and that there is no guarantee of receiving a scholarship.

I attest to this application being true, and complete to the best of my knowledge and I authorize the Federation to check its validity. I understand this is only an application for a scholarship and that there is no guarantee of receiving a scholarship.

I attest to this application being true, and complete to the best of my knowledge and I authorize the Federation to check its validity. I understand this is only an application for a scholarship and that there is no guarantee of receiving a scholarship.


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