Jewish Education Scholarship Application Form

2016-2017 School Year

Your application will be considered after you email us your most recent tax return.
Child Information
Child Name *
Child Name
Gender *
Date of Birth *
Date of Birth
Address *
Home Phone *
Home Phone
Parent Information
Father's Name *
Father's Name
Father's Cell *
Father's Cell
Mother's Name *
Mother's Name
Mother's Cell *
Mother's Cell
Please list your child's siblings and their ages
(occupational therapy, speech therapy, special education services etc)
Does your child have any allergies? If yes, please specify
Does your child take any medication/s regularly? If yes, please specify
Does your child have any phisical or emotional issues?
School Year Program *
The school year is from September-June
Summer Program Weeks
Choose which weeks you would like your child to attend for all 5 days from 9:00-2:30. If you would like extended care for all the weeks check "extended care" as well.
Summer Program Option