Scholarship Application - Camp Gan Israel of the North Peninsula

Scholarship Application
The Deadline for submitting a scholarship application is May 1st 2018. You will be contacted with the committee's decisions when it becomes available.

All applications must include a copy of your 2017 tax returns, tax returns can be emailed to rabbiyale@chabadnp.com with the header "CGI Scholarship Committee - Confidential".

Please fill out this form as accurately as possible. If you have any questions or difficulties please contact our director, Yale Spalter at (650)667-9556 or rabbiyale@chabadnp.com
Parent Information
Mother's Full Name
First NameLast Name
E-mail
Phone Number
Area CodePhone Number
Job Title
City of Residence
Marital Status
Father's Full Name
First NameLast Name
E-mail
Phone Number
Area CodePhone Number
Job Title
City of Residence
Marital Status
Financial Information
Parent(s) claiming the applicant for tax purposes (2017 tax returns are required). Please answer these questions as listed on your tax returns.
2017 federal tax return: Adjusted gross income*
2017 federal tax return: Filing status*
Total number of exemptions claimed (Line 6D on your 1040 returns)*
Number of children in the family*
Number of adults in the family*
Non-taxable income (unlisted)*
Expected Income 2018*
Statement of Need:

Describe any special expenses or changes in family or economic circumstances over the past year that support your request for financial aid this year. Include known events in 2018 that will impact your family. (new child, Bar Mitzvah, etc). Please mention if you are a single parent, first generation émigré, special needs family member, or have multiple children attending. OR if a parent has lost their job or work hours were reduced, please indicate the date, the estimated cost of this change, and which parent (one or both parents) was effected. The more details you provide, the better our committee can understand your situation.
Reference:
Please provide a rabbinic or personal reference who may be contacted to confirm the information provided above.
Full Name*
First NameLast Name
Phone Number*
Area CodePhone Number
E-mail*
Tuition Fees Information
Amount of full tuition*
What can you pay towards camp tuition?*
Funding from any other agencies or grants*
YesNo
Please explain source
Funding from any other agencies or grants*
Signature:
I confirm that all the information contained above is accurate to the best of my knowledge and I understand that if this information is found to be false I may be disqualified from receiving aid and may be required to return any funds received.
Full Name*
First NameLast Name
Date*
MonthDayYear
Email (For email confirmation and receipt)*
After submitting this form, please email a copy of your 2017 tax return to rabbiyale@chabadnp.com . Please include as a header: "CGI Scholarship Committee - Confidential". If you do not yet have your 2017 returns please contact our office. 650.453.8136
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Parent Information

Financial Information