Summer Camp Scholarship Application 2026

JFS Keep Families Working Summer Camp Scholarship Program

Parent 1

PARENT #1: First Name

Middle Initial

Last Name

Phone

Primary Address

Address Line 1 Address Line 2 City State ZIP Postal Code

Date of Birth

MM slash DD slash YYYY

Age

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.

Employer Company/Name

Marital Status

Veteran Status

Religious Affiliation

Ethnicity

Emergency Contact Person

First Last

Relationship

Phone

Parent 2

PARENT #2: First Name

Middle Initial

Last Name

Phone

Primary Address

Address Line 1 Address Line 2 City State ZIP Postal Code

Date of Birth

MM slash DD slash YYYY

Age

Employer

Marital Status

Veteran Status

Religious Affiliation

Ethnicity

Emergency Contact Person

First Last

Relationship

Phone

Camp Scholarships Intake- Additional Questions

How Many Children?(Required)

Child 1

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Child 2

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Child 3

Child's Name

First Last

Age

Camp Name

# Weeks Attending

Camp Total Cost

Child 4

Child's Name

First Last

Camp Name

# Weeks Attending

Camp Total Cost

Child 5

Child's Name

First Last

Camp Name

# Weeks Attending

Camp Total Cost

Child 6

Child's Name

First Last

Camp Name

# Weeks Attending

Camp Total Cost

Additional Household Members

Total Number of People in Household

(including yourself)

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 - HOA

INCOME - Pension

EXPENSE - Utilities (FPL/Water/Cable)

INCOME - Unemployment

EXPENSE - Car payment

INCOME - Food Stamps

EXPENSE - Car insurance

INCOME - Child Support

EXPENSE - Health/Life insurance

INCOME - Alimony

EXPENSE - Food/Monthly Staples:

INCOME - Investments

EXPENSE - Credit cards

INCOME - Pension / 401

EXPENSE - Miscellaneous (other)

INCOME - Other Income

Total

Total Monthly Family Income

Total Monthly Family Expenses

Financial Assistance Requested:

Counseling / Psychotherapy

Psychiatry / Med-management

Psycho-educational Testing

Cooperman Center

All other Financial Assistance (FA, Summer Camp, DV, Outreach, Disability Inclusion Services)

Food Programs (Meals on Wheels or Food Pantry)

Do you receive any other services from JFS?

Yes

Interested in learning more?

Yes

Notes (Optional):

Volunteer Opportunities Volunteering is an excellent way to give back to JFS for the services we are providing to you and/or your family. We have many opportunities for you and your family to participate in throughout the year. We will be sending you information of these amazing volunteer opportunities. Please consider volunteering and giving back to JFS.

Upload PDF Files(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 50 MB.

Please note we can only accept .PDF documents O

Date(Required)

MM slash DD slash YYYY

Signature(Required)

I hereby certify that all information I have provided is accurate and my statements of need are truthful. I understand Ruth & Norman Rales Jewish Family Services (JFS) requires my consent for the collection, use and disclosure of personal information. For the purpose of assessing and completing my application for Financial Assistance, I authorize JFS to collect, use and disclose this personal information internally and/or with outside vendors, and community agencies in order to confirm the need of the requested assistance and/or coordinate available services.