CTEEN SCHOLARSHIP FORM The Yitzchak and Rivka Zhivalyuk Jewish Education Scholarship Fund offers financial aid based on economic need for Camp Gan Izzy Summer and Winter Camps, JKidz Hebrew School and CTeen. We offer partial scholarships and payment plans based on your level of need. After the committee reviews your application, you will typically receive your answer within 1-2 weeks. We are applying for CTeen for the year of:* Parent #1 Information Full Name* First Name Last Name Phone Number* Area Code Phone Number Employer* Job Title* Marital Status* City of Residence* Religious Affiliation* Parent #2 Information Full Name* First Name Last Name Phone Number* Area Code Phone Number Employer* Job Title* Marital Status* City of Residence* Religious Affiliation* Child #1 Information Full Name* First Name Last Name School Name* * Public Private Grade (Upcoming Fall)* Which teen program(s) did this child attend last year, if any?* What was the tuition amount?* Did you receive a scholarship last year?* Yes No Unsure If yes, please list amount* Child #2 Information Full Name First Name Last Name School Name Public Private Grade (Upcoming Fall) Which teen program(s) did this child attend last year, if any? What was the tuition amount? Did you receive a scholarship last year? Yes No Unsure If yes, please list amount Child #3 Information Full Name First Name Last Name School Name Public Private Grade (Upcoming Fall) Which camp did this child attend last summer, if any? What was the tuition amount? Did you receive a scholarship last year? Yes No Unsure If yes, please list amount Would you be willing to help out in exchange for some of your CTeen fees?* If yes, do you have any particular skills that you would like to share with our teens or staff or any other bartering ideas?* STATEMENT OF NEED Describe any circumstances that support your request for financial aid. The more details you provide, the better we can understand your situation.* REFERENCE Please provide a personal or synagogue reference who may be contacted to confirm the information provided Full Name* First Name Last Name Phone Number* Area Code Phone Number TUITION FEES INFORMATION Amount of full tuition* What can you pay towards tuition?* How much can you receive from other sources (friends or family)?* Please explain source* Funding from any other agencies or grants (Synagogue/Temple, Jewish Federation, JFLA, etc.)* Please explain source* Total amount requested* SIGNATURE I confirm that all the information contained above is accurate to the best of my knowledge. Signature* E-mail* Date* Month Day Year  Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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