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Summer Camp Scholarship Application
Summer Camp Scholarship Application
ralesjfs
2023-10-03T20:46:16+00:00
Consent
(Required)
I have read the Camp Scholarship Prerequisite Letter
Please read the "Letter to Applicants" PDF prior to completing this application.
Click HERE to read the "Letter to Applicants" PDF
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
MM slash DD slash YYYY
Marital Status
Select...
Single
Married
Divorced
Separated
Did you apply last year?
Select...
Yes
No
Not Sure
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
MM slash DD slash YYYY
Marital Status
Select...
Single
Married
Divorced
Separated
Did you apply last yesr?
Select...
Yes
No
Not Sure
Employer Company/Name
Employer Address
Employer Phone#
Occupation
How long at current job?
Primary Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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)
0
1
2
3
4
5
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 - Food Stamps
EXPENSE - Car payment
INCOME - Unemployment
EXPENSE - Gas and Auto
INCOME - Disability
EXPENSE - Car insurance
INCOME - Child Support
EXPENSE - Health/Life insurance
INCOME - Alimony
EXPENSE - Medication
INCOME - Investments
EXPENSE - Food
INCOME - Other Income
EXPENSE - Credit cards
Total Monthly Family Income
EXPENSE - Other
Total Monthly Family Expenses
EXPENSE - Tuition/Florida Prepay
Consent
(Required)
I agree to receiving emails and/or phone calls from Ruth & Norman Rales JFS for the purpose of following up on this form submission.
Consent
(Required)
I agree to EMAIL required document PDFs to JFS at WendyG@ralesjfs.org in order to complete this Application. (Or send via USPS Mail)
Verification of income by paystubs or direct deposit on bank statements; W2 for all jobs worked and signed current 2023 Tax return; Three months of current bank statements for all checking and savings accounts; copy of current lease or mortgage. - Screenshots of documents are not accepted. PDF files only! If you email these document PDFs to JFS (wendyg@ralesjfs.org), we recommend you use an encrypted email method.
I will forward required documents via:
(Required)
EMAIL to WendyG@RalesJFS.org
U.S. Postal Service mail to 21300 Ruth & Baron Coleman Blvd, Boca Raton, FL 33428
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.
Δ
Applications will be accepted beginning in January 2024 for the next camp season.
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