Scholarship Application - MyJewishCamp.org

Please be sure to complete all requested information and sign on the bottom of the form.
How did you hear about our camp?*
Child's Full Name*
First Name Last Name

Address*

Phone Number*

Area Code Phone Number
E-mail*
Child's Age*
Birth Date*

Month Day Year
How long would you like your child to attend camp? *
How much do you feel you can afford to pay per child, per week?*
How many children are in your family?*
Marital Status (Head of Family)*

MarriedSeparatedDivorcedWidowed
Mother's Yearly Income
Mother's Occupation
Father's Yearly Income
Father's Occupation
What is your family's total income before deductions? (Include wages of all working members, welfare payments, social security, and all other income)*
The above answer is your family's:*

Weekly total incomeMonthly total incomeYearly total income
Monthly Rent
Do you own a home?*
School*
Tuition*
What are your reasons for requesting this scholarship?*
Personal reference:*
Signature of Parent*
Application Date*

Month Day Year
Unless there is a reasonable absence, I commit to compensating CGI with full tuition if my child misses the camp days they are accepted for.

Yes
I would like to receive news and updates by email
Should be Empty:

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