Hebrew School Scholarship Form 2022/2023Parent #1Parent #1 Name:*First NameLast NameParent #1 Email:*Parent #1 Phone Number:*Area CodePhone NumberParent #1 Employers Name:*Parent #1 Job Title:*Parent #1 Marital Status:*MarriedSeparatedDivorcedWidowSingleParent #2Parent 2 Name:First NameLast NameParent 2 Email:Parent 2 Phone Number:Area CodePhone NumberParent 2 Employers Name:Parent #2 Job Title:Parent #2 Marital Status:MarriedSeparatedDivorcedWidowSingleChild(ren)Child #1 Name*First NameLast NameChild #1 Date of Birth:*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearProgram 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- $1300Add another childChild #2 NameFirst NameLast NameChild #2 Date of Birth:1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearProgram 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- $1300Add another childChild #3 NameFirst NameLast NameChild #3 Date of Birth:1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearProgram 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- $1300Add another childChild #4 NameFirst NameLast NameChild #4 Date of Birth:1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearProgram 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- $1300Add another childChild #5 NameFirst NameLast NameChild #5 Date of Birth:1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearProgram 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- $1300FinancialWhat 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 NameThank you for filling out the scholarship form. Please go back to the CHS registration form and submit your application.SubmitShould be Empty: This page uses TLS encryption to keep your data secure.