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ב"ה

Education Chabad Hebrew School

Hebrew School Scholarship Form

Hebrew School Scholarship Form 2022/2023
Parent #1
Parent #1 Name:*
First NameLast Name
Parent #1 Email:*
Parent #1 Phone Number:*
Area CodePhone Number
Parent #1 Employers Name:*
Parent #1 Job Title:*
Parent #1 Marital Status:*
Parent #2
Parent 2 Name:
First NameLast Name
Parent 2 Email:
Parent 2 Phone Number:
Area CodePhone Number
Parent 2 Employers Name:
Parent #2 Job Title:
Parent #2 Marital Status:
Child(ren)
Child #1 Name*
First NameLast Name
Child #1 Date of Birth:*
MonthDayYear
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 NameLast Name
Child #2 Date of Birth:
MonthDayYear
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 NameLast Name
Child #3 Date of Birth:
MonthDayYear
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 NameLast Name
Child #4 Date of Birth:
MonthDayYear
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 NameLast Name
Child #5 Date of Birth:
MonthDayYear
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 NameLast Name
Thank you for filling out the scholarship form.
Please go back to the CHS registration form and submit your application.
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Lubavitch of Montgomery County 1311 Fort Washington Avenue Fort Washington, PA 19034-1709
215-591-9310

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