Hebrew School Scholarship Form 2023/2024 Parent #1 Parent #1 Name:* First Name Last Name Parent #1 Email:* Parent #1 Phone Number:* Area Code Phone Number Parent #1 Employers Name:* Parent #1 Job Title:* Parent #1 Marital Status:* MarriedSeparatedDivorcedWidowSingle Parent #2 Parent 2 Name: First Name Last Name Parent 2 Email: Parent 2 Phone Number: Area Code Phone Number Parent 2 Employers Name: Parent #2 Job Title: Parent #2 Marital Status: MarriedSeparatedDivorcedWidowSingle Child(ren) Child #1 Name* First Name Last Name Child #1 Date of Birth:* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Program Selection: * "First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm- $1300 Add another child Child #2 Name First Name Last Name Child #2 Date of Birth: 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Program Selection: "First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm- $1300 Add another child Child #3 Name First Name Last Name Child #3 Date of Birth: 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Program Selection: "First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm- $1300 Add another child Child #4 Name First Name Last Name Child #4 Date of Birth: 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Program Selection: "First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm- $1300 Add another child Child #5 Name First Name Last Name Child #5 Date of Birth: 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Program Selection: "First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm- $1300 Financial What is your total household income?** 2021 Tax Return: Adjusted Gross Income?* 2021 Tax Return: Filing Status?* Non-taxable Income (unlisted)?* Expected Income 2022?* Do you own or rent your home?* What is your monthly mortgage or rent?* What is your monthly car(s) payment? (If you have one).* Number of dependents in the family?* What is the total you feel you can pay towards your child(rens) CHS tuition?** How much can you receive from other sources (family or friends)?** Describe any circumstances that support your request for financial aid. The more details you provide, the better the financial advisory board can understand your situation.* Signature * I confirm that all the information contained above is accurate to the best of my knowledge.I understand this form is not considered complete until I have sent in my 2021 tax return(s) to [email protected] Full Name* First Name Last Name Thank you for filling out the scholarship form.Please go back to the CHS registration form and submit your application. Submit Should be Empty: This page uses TLS encryption to keep your data secure.