ISRAEL SCHOLARSHIPS - HIGH SCHOOL

ISRAEL SCHOLARSHIPS - HIGH SCHOOL

Be sure to have all the necessary information with you prior to beginning the application as you will need to upload the necessary items. You can find information regarding the necessary items at https://www.jewishbroward.org/portal/high-school-israel-experience-scholarships It is also highly suggested that you include a letter explaining any circumstances affecting your finances which may not be evident from the tax return.
APPLICANT NAME *

First Name Last Name
TODAY'S DATE *

Month Day Year
Date
DATE OF BIRTH *

Month Day Year
Date
NAME OF HIGH SCHOOL *
CURRENT GRADE *
CONTACT INFORMATION
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
HOME PHONE *

Area Code Phone Number
APPLICANT CELL PHONE *

Area Code Phone Number
APPLICANT EMAIL ADDRESS *
example@example.com
Parents are *

Married Divorced Separated Widow/Widower
PARENT 1 NAME *

First Name Last Name
PARENT 1 EMAIL ADDRESS *
example@example.com
PARENT 2 NAME

First Name Last Name
PARENT 2 EMAIL ADDRESS
example@example.com
PARENT 1 CELL PHONE *

Area Code Phone Number
PARENT 2 CELL PHONE

Area Code Phone Number
Parent 1 Occupation *
Parent 2 Occupation
JEWISH/ISRAEL ACTIVITIES AND EXPERIENCES
SYNAGOGUE AFFILIATION (IF NONE, WRITE N/A) *
LIST YOUR INVOLVEMENT WITH ANY JEWISH ORGANIZATIONS, YOUTH GROUPS, CLUBS BOTH IN SCHOOL AND/OR OUTSIDE OF SCHOOL (if none, indicate N/A) *
LIST ANY ISRAEL PROGRAM IN WHICH YOU HAVE PREVIOUS PARTICIPATED. INCLUDE NAME AND DATES OF PARTICIPATION (if none, indicate N/A) *
DID YOU RECEIVE FINANCIAL ASSISTANCE *

YES NO
IF SO, WHAT WAS THE AMOUNT
FROM WHOM?
Have you traveled to Israel previously with friends or family? *

Yes No

NAME OF PROGRAM FOR WHICH YOU ARE APPLYING NOW *
PROGRAM DATES *
SPONSORED BY *
COST OF THE PROGRAM *
LIST OTHER COSTS (IE AIRFARE, TIPS, INSURANCE, ETC. PLEASE BE SPECIFIC *
PROGRAM WEBSITE *
AMOUNT OF SCHOLARSHIP REQUESTED *
HOW MUCH WILL BE CONTRIBUTED BY PARENTS? *
HOW MUCH BY PARTICIPANT'S JOB? *
HOW MUCH FROM SAVINGS? *
HOW MUCH FROM OTHER FAMILY MEMBERS *
OTHER SCHOLARSHIPS (INCLUDE SOURCE AND AMOUNT -including program itself)
ADDRESS TO WHICH CHECK SHOULD BE MAILED (PROGRAM SPONSOR ADDRESS) *

Please upload your most current income tax return Be sure it is signed with all areas completed *

Browse Files

Cancel of
Accompany letter, if applicable

Browse Files

Cancel of
Upload essay here *

Browse Files

Cancel of
Compose and upload a letter agreeing to 10 hours of community service and agreement to write a note after the experience. *

Browse Files

Cancel of
Acceptance letter from program

Browse Files

Cancel of

ATTESTATION

REFUNDS/CANCELLATION

Scholarships awarded by the Jewish Federation of Broward County are contingent upon completion of the program and all requirements of receiving the award. Failure to do so, requires the participant to reimburse the Federation the scholarship amount.

By signing below, we confirm the information submitted on this form and other required material is truthful and accurate. We understand the applicant is responsible for completing 10 hours of community service with a Jewish organization prior to their Israel experience and submission of a thank you letter and/or video thank you, sharing their experiences. These items should all be sent to israel@jewishbroward.org
In addition, I consent, for all purposes, to being interviewed, photographed, videotaped and/or filmed by the Jewish Federation of Broward County and/or ts affiliates, for use in all media and in all manner of promotion, including, but not limited to, marketing, advertising, editorial and display. I further consent to allowing the the Jewish Federation of Broward County, and its affiliates to make use of my writing, spoken and written words, art work, music and/or photographs pertaining to the Israel program in which I participated.

I release the reporter/photographer/cameraperson/editor/staff and his/her nominees and designees, from liability for any violation of any personal or proprietary right I may have in connection with such sale, reproduction or use.
Use your mouse to sign below.
APPLICANT SIGNATURE *

Clear
PARENT/GUARDIAN SIGNATURE *

Clear
Should be Empty: