Student Information

Education and Work History

Program Information

Funding Information

Please complete the section below to indicate how you plan to cover the costs of the program. Please do not leave any portion blank.

Applicants are required to seek funding from sources other than the Federation. 

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 applicant, not by parent.

Current Employment:

Summer Employment 2020*

Jewish Involvement

Other Funding Sources

in order for your application to receive serious consideration you must seek out additional funding options.

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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