Scholarship Application - Camp Gan Israel

Scholarship Application
The Deadline for submitting a scholarship application is May 31st. You will be contacted with the committee's decisions when it becomes available.
All applications must include a copy of your tax return. tax returns can be emailed to secretary@jewishbrevard.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 email secretary@jewishbrevard.com
Parent Information
Mother's Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
City of Residence*
Job Title*
Marital Status*
Father's Full Name*
First Name Last Name
Phone Number*
Email*
City of Residence*
Job Title*
Marital Status*
Financial Information
Parent(s) claiming the applicant for tax purposes (most recent tax return is required). Please answer these questions as listed on your tax returns.
Federal tax return: Adjusted gross income**
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)*
This year's expected Income*
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 upcoming known events 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.
Statement of Need:*
Reference:
Please provide a rabbinic or personal reference who may be contacted to confirm the information provided above.
Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
Tuition Fees Information
How many children will be attending camp?*
How many weeks will each child be attending camp for?*
Amount of full tuition*
What can you pay towards camp tuition?*
Funding from any other agencies or grants

YesNo
Please explain source
eSignature:
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 Name Last Name
Date*

Month Day Year
Email (For email confirmation and receipt)*
After submitting this form, please email a copy of your tax return to info@campganizzy.com . Please include as a header: "CGI Scholarship Committee - Confidential". If you do not yet have your most recent tax return please contact our office. 321.777.2770
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