Chabad Hebrew School Scholarship Application

Personal Information
Fathers Name*
First Name Last Name
Home Phone Number*
Work Phone Number
Cell Phone Number*
Occupation
Mothers Name*
First Name Last Name
Home Phone Number*
Work Phone Number
Cell Phone Number*
Occupation

Address*

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

Financial Information
Do you*

OwnRent
Monthly rent or mortgage payment:*
Father's Employer’s Name, Address and Telephone number:*
Mother's Employer’s Name, Address and Telephone number:
Father current gross monthly earnings:*
Mother current gross monthly earnings:
Number of Children in the family*
Does your child(ren) attend private school?*

YesNo
If Yes, Name of school*
Tuition per school year:
I can afford to pay a total per month for my child(ren) to attend the Chabad Hebrew School:*
Please State the reason(s) why you feel a scholarship should be granted in your situation*
I hereby give the Chabad Hebrew School permission to look into my place of employment, my children’s schools or any other information on this form for verification.* Signature
Date:*

Month Day Year
This Scholarship application must be accompanied by an application for Chabad Hebrew School. The application must be completely filled out with an accompanying refundable check or credit card for the amount of $100 for per child.
Please note: Your check and will not be deposited and credit card not charged until scholarship details have been mutually agreed upon and approved by all parties concerned.
ALL INFORMATION WILL BE KEPT IN STRICT CONFIDENCE.
Please Read and Check this Box*

Unless there is a reasonable absence, I commit to compensating Chabad Hebrew School with pro-rated tuition if my child misses the school days they are accepted for.
Month Day Year
at Hour Minutes
Refundable application fee

$100
Total

$100.00

Payment

Credit Card Check Payment

Postal / Zip Code

Country

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