Summer Camp Assistance

Families whose residence is within south Palm Beach County (Boca Raton, Delray Beach and Highland Beach) are eligible to receive scholarship assistance for summer camp.

• Scholarship assistance is available for ANY camp.
– Pre-school through high school
– Day or overnight
– In or out of state
• Families must meet the financial criteria of eligibility set forth by JFS.

Summer Camp Scholarship Application

PARENT #1: First Name

Middle Initial

Last Name

Parent Email Address(Required)

A copy of this form, including your responses, will be emailed to the above email address when the "Submit" button is clicked.

Parent Best Contact Phone#

Date of Birth

Marital Status

Did you apply last year?

Employer Company/Name

Employer Address

Employer Phone#

Occupation

How long at current job?

Add Another Parent?

Yes

PARENT #2: First Name

Middle Initial

Last Name

Date of Birth

Marital Status

Did you apply last yesr?

Employer Company/Name

Employer Address

Employer Phone#

Occupation

How long at current job?

Primary Address

Address Line 1 Address Line 2 City State ZIP Postal Code

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Scholarship Amount Awarded from Camp

Scholarship Amount Awarded from Other Sources

Add Child 2?

Yes

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Scholarship Amount Awarded from Camp

Scholarship Amount Awarded from Other Sources

Add Child 3?

Yes

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Scholarship Amount Awarded from Camp

Scholarship Amount Awarded from Other Sources

Additional Household Members

How many additional household members?(Required)

Name

Relationship

Age

Employed

Name

Relationship

Age

Employed

Name

Relationship

Age

Employed

Name

Relationship

Age

Employed

Name

Relationship

Age

Employed

Name

Relationship

Age

Employed

Monthly Family Income:

Monthly Expenses:

INCOME - SS / SSI / SSDI

EXPENSE - Rent/Mortgage

INCOME - Employment Wages

EXPENSE - Electric/ Water / Gas

INCOME - Pension

EXPENSE - Phone (cell, cable & internet)

INCOME - Unemployment

EXPENSE - Car payment

INCOME - Food Stamps

EXPENSE - Food

INCOME - Workers Comp

EXPENSE - Car insurance

INCOME - Disability

EXPENSE - Health/Life insurance

INCOME - Child Support

EXPENSE - Other insurance

INCOME - Alimony

EXPENSE - Medication

INCOME - Investments

EXPENSE - Credit cards

INCOME - Other Income

EXPENSE - Gas and Auto

INCOME - Misc Income

EXPENSE - Other

Total Monthly Family Income

Total Monthly Family Expenses

Signature(Required)

I hereby certify that all information I have provided is accurate and my statements of need are truthful. By signing below, I authorize JFS to share personal information collected about me or my family in its possession, including but not limited to name, address, and other personal and identifiable information, and the type of assistance requested or received from this organization, with vendors and other community agencies and resources in order to confirm the need for or provision of the requested assistance and/or coordinate available services and assistance. Please note that if at any time, a change in circumstance occurs, this must be communicated with the VP of Financial Services and Food Programs at JFS.

Give specific detailed information that you feel we should know about when processing your request for financial assistance.

If you have questions or to check the status of a scholarship request, please contact:

Wendy Goodman
Associate VP of Financial Assistance
Phone: 561.852.3171 Fax 561.852.3332 Email: WendyG@ralesjfs.org

Summer Camp Assistance