Israel Experience Scholarship Application

This form must be complete by the student.

Israel Travel *

Length of Program *

Dates *

Amount of support requested *

Enter dollar amount in this field

Is your family a member of Beth Shalom? *

Yes
No

Name of Student *

First

Last

Gender *

Male
Female
Gender neutral
Would prefer not to specific

Birth date *

Grade *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell phone *

Email *

Parent Name #1 *

First

Last

Parent Name #2 *

First

Last

Please describe your expected Israel Experience? *

If you know the names/addresses of others participating in the same program please list them here: *

Have you participated in other Jewish organizations or activities? *

Yes
No

If so, please list them:

How do you think you will grow Jewishly by attending this program?

Would you be willing to speak or write an article for the MIshpachtenu about your experience? *

Yes
No

What part(s) of our Shabbat service can you lead? *

Explain briefly any other special circumstances the committee should be aware of.

CERTIFICATION *

By checking this box, I certify that the information provided herein, to the best of my knowledge, is true accurate and complete.

FINANCIAL ASSISTANCE IS REVIEWED BY A COMMITTEE OF THE BOARD OF TRUSTEES OF CONGREGATION BETH SHALOM.

All information will be kept on a confidential basis by the Scholarship Committee. In return we request that you treat such matters with confidentiality as well. In a timely fashion a committee member will contact you.

Israel Experience Scholarship Application

This form must be complete by the student.

FINANCIAL ASSISTANCE IS REVIEWED BY A COMMITTEE OF THE BOARD OF TRUSTEES OF CONGREGATION BETH SHALOM.

Summer Camp Scholarship Application

Counting the Omer Yoga with Tiferet - Starts Sunday, April 28