Summer Camp Scholarship Application

This form must be complete by the student.

Summer Camp - Name of Camp: *

Type of camp *

Day camp
Overnight camp

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

Why do you want to attend this camp? *

How do you think you will grow Jewishly by attending the camp? *

Are you a member of Jewish youth groups? *

Yes
No

Select all that apply

What chapter activities have you actively planned, if any: State the activity and if you were a chair, or an active committee member. It is not necessary to limit your activities to the past year.

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

Yes
No

Do you attend J-Line? *

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.

Summer Camp 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.

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