Camp Scholarship Application

You will be contacted with the committee's decisions when it becomes available.

Please fill out this form completely and accurately. (The scholarship committee will award scholarships based on this form). If you have any questions or difficulties, please contact the Camp Director, Rabbi Yishai at 248-788-4000 ext. 1107 or [email protected].

Please note: The scholarship grants are based on the amount of weeks you will be registering for. Any changes after you submit this form may result in forfeiting your scholarship.

Full Name*

Prefix First Name Last Name

Employer*

Job Title*

Cell Phone #*

Area Code Phone Number

E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status*

Full Name

Prefix First Name Last Name

Employer

Job Title

Cell Phone #

Area Code Phone Number

E-mail

Marital Status

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Grade (Currently)*

Registering for camp*

YesNo

Check the weeks which you would like to register for

Week 1 - Aug 5-9Week 2 - Aug 12-16Week 3 - Aug 19-22

Will you need Extended Care? (AM) It will be assumed you will need the same extended care for all children registering for camp unless otherwise stated

Will you need Extended Care? (PM) It will be assumed you will need the same extended care for all children registering for camp unless otherwise stated

Total Tuition Cost (without scholarship)

Go to campganisrael.net/campdates for cost

Full Name

First Name Last Name

Birth Date

Month Day Year

Grade (Currently)

Registering for camp

YesNo

Check the days which you will be registering for

Week 1 - Aug 5-9Week 2 - Aug 12-16Week 3 - Aug 19-22

Total Tuition Cost (without scholarship)

Go to campganisrael.net/campdates for cost

Full Name

First Name Last Name

Birth Date

Month Day Year

Grade (Currently)

Registering for camp

YesNo

Check the days which you will be registering for

Week 1 - Aug 5-9Week 2 - Aug 12-16Week 3 - Aug 19-22

Total Tuition Cost (without scholarship)

Go to campganisrael.net/campdates for cost

Full Name

First Name Last Name

Birth Date

Month Day Year

Grade (Currently)

Registering for camp

YesNo

Check the days which you will be registering for

Week 1 - Aug 5-9Week 2 - Aug 12-16Week 3 - Aug 19-22

Total Tuition Cost (without scholarship)

Go to campganisrael.net/campdates for cost

Describe any special expenses or changes in family or economic circumstances over the past year that support your request for financial aid this year.

*

Please provide a rabbinic or personal reference who may be contacted to confirm the information provided above.

Reference Name*

First Name Last Name

Reference Phone #*

Area Code Phone Number

Total amount of Tuition for all children (without scholarship)*

What can you pay towards camp tuition?*

Total scholarship requested*

We offer the ability to help pay camp tuition through working at camp for various positions. Please list the positions you would like to apply for and the details regarding hours.

I would be willing to work in the following positions

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.

Signature*

Date*

Month Day Year

Comments

I would like to receive news and updates by email

Camp Gan Israel

at The Shul

Parent #1 Info

Parent #2 Info

Child #1 Info

Child #2 Info

Child #3 Info

Child #4 Info

Statement of Need

Reference

Tuition Fees Information

Work at camp

Signature

Camp Address