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2023 Congregation Beth Israel Jewish Summer Camp Scholarship Application
Please verify reCaptcha before submitting the form.
Answer all questions completely. All information will be treated with the strictest confidentiality. If you have questions about completing this application, call Kerri Zerlin, Assistant Director of the MBJLC, at 713-771-6221 *312 or email at
kzerlin@beth-israel.org
. Please submit this application by
March 24, 2023
.
I. Student Information
*
Student's Name (first and last)
*
Age
Male
Female
*
Birthdate
*
Grade as of Fall 2022
Please Select One
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please Select One
Public School
Private School
*
Name of School
*
Applying for scholarship to
II. Parent/Guardian Information
Parent/Guardian 1:
Please Select One
Parent
Stepparent
Guardian
Grandparent
*
First Name
*
Last Name
*
Email
*
Cell Phone
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
ZIP
*
Child is here ___% of the time
Religious Affiliation
Jewish
Other
*
Employer
*
Title/Position
*
Years with employer
Work Phone
If unemployed, date unemployed, gross salary and profession before unemployed
Parent/Guardian 2:
Parent
Stepparent
Guardian
Grandparent
First Name
Last Name
Email
Cell Phone
Address
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
Child is here ___% of the time
Religious Affiliation
Jewish
Other
Employer
Title/Position
Years with employer
Work Phone
If unemployed, date unemployed, gross salary and profession before unemployed
III. Family Information
*
Parent/Guardians' Marital Status
Please Select One
Married
Widowed
Divorced
Both deceased
Single
Separated
Remarried
If divorced, single, or separated, complete the following:
Date of divorce or separation:
Custodial parent:
IV. PARENTS’ FINANCIAL INFORMATION (Please provide ALL information requested)
*
Has your family received financial assistance for camp or trips in previous years?
Please Select One
Yes
No
*
Special Circumstances. Please explain why financial aid is needed by giving us any additional information that would be helpful for us to know. This might include unusual expenses you had in the past year or expect next year, significant changes in income in recent years or expected next year, illness, housing or employment difficulties, debts, support of aged relatives, etc.
*
If for ANY reason your membership at Congregation Beth Israel is not in good standing, please explain your circumstances.
Note: You must be a member in good standing with MBJLC tuition, fees, and fair share dues up to date for the 2021-2022 fiscal year in order to be eligible for a scholarship.
V. COST/FUNDING INFORMATION
COSTS
*
Total Camp Tuition
FUNDING
*
Parent Contribution
*
Congregation Request
*
Other income/contributions
*
Total
We have reviewed this application and affirm that the information given is complete and correct.
Signature of parent or guardian
Date
Signature of parent or guardian
Date
Fri, February 3 2023
12 Sh'vat 5783
Today's Calendar
Torah 101 BINGE Group
: 12:00pm
Family Shabbat
: 6:00pm
Shabbat Services
: 6:30pm
Friday Night
Family Shabbat
: 6:00pm
Shabbat Services
: 6:30pm
Shabbat Day
Saturday Morning Minyan
: 8:30am
Shabbat Morning Torah Study
: 9:45am
Jewish Meditation BINGE Group
: 11:15am
Upcoming Programs & Events
Feb
3
Family Shabbat
Friday, Feb 3 6:00pm
Feb
5
Pickleball
Sunday, Feb 5 9:00am
Feb
5
Sisterhood of Congregation Beth Israel Mah Jongg Event
Sunday, Feb 5 1:00pm
Feb
7
Pickleball Tuesdays
Tuesday, Feb 7 6:30pm
Feb
7
Board of Trustees Meetings
Tuesday, Feb 7 7:00pm
This week's Torah portion is
Parashat B'shalach
Shabbat, Feb 4
Tu BiSh'vat
Monday, Feb 6
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Fri, February 3 2023 12 Sh'vat 5783