JEWISH IDENTITY & ISRAEL TRAVEL PROGRAM SCHOLARSHIP APPLICATION HIGH SCHOOL & POST HIGH SCHOOL ISRAEL LEARNING EXPERIENCES ELIGIBILITY - To be eligible to receive financial aid, the applicant must: Demonstrate family financial need. Be a resident of the greater Cleveland area. Participate in a JEC-approved Israel Learning Experience. First or Second-timer to Israel on a peer experience. Please complete this form accurately and completely. This application and all requested documents must be submitted to the JEC by December 1st for winter/spring programs and March 31st for summer/fall programs. Awards are allocated as a grant, interest-free loan, or combination of both. All information is kept confidential. This application requires you to upload the following documents. Please have these documents ready to submit as you complete this application: Complete and signed copy of parent's most recent Federal Income Tax Return 1040 Form, including schedules, if filed Verification of program cost from sponsoring organization (copy of brochure or letter from organization.) Credit card statement (if credit card balance exceeds $20,000) This application does not have a save feature. Please review the questions and gather the required information before starting. Please contact Teresa Bruno with any questions or concerns (216-377-6004, tbruno@jecc.org) Mail Sent Successfully. PERSONAL INFORMATION Please complete this form accurately and completely. This application plus the parent’s current IRS 1040 tax forms must be submitted to the JEC by December 1st for winter/spring programs and March 31st for summer/fall programs. Awards are allocated as a grant, interest-free loan, or combination of both. All information is kept confidential. DATE OF APPLICATION DATE OF BIRTH Applicants First Name Applicants Last Name ADDRESS City State Country Zip Contact Phone Number PROGRAM DEPARTURE DATE PARENT’s/GUARDIAN’s EMAIL STUDENT’S EMAIL NAME OF PROGRAM Length of Program Short Term [Less than three months.] Long Term [More than three months.] PROGRAM ADDRESS City State Country Zip CURRENT SCHOOL (SECULAR EDUCATION) GRADE Select Grade 1 2 3 4 5 6 7 8 9 10 11 12 Parent/Guardian 1 NAME MARITAL STATUS Select Marital Status Divorced Married Separated Single Widower ADDRESS (if different from above) WORK/CELL PHONE Parent/Guardian 2 NAME MARITAL STATUS Select Marital Status Divorced Married Separated Single Widower ADDRESS (if different from above) WORK/CELL PHONE APPLICANT'S JEWISH INVOLVEMENT- Please answer where applicable SYNAGOGUE OR TEMPLE AFFILIATION Select Synagogue #N/A #N/A Attending Jewish Day School #Other Agudath B'nai Israel Ahavas Yisrael Aish HaTorah Am Shalom of Lake County Anshe Chesed-Fairmount Temple Ashkenas B'nai Jeshurun Congregation B'nai Torah Congregation Bais Dovid Cleveland Bais Avrohom Beachwood – University Heights Kollel Beachwood Kehilla Beth El-Heights Synagogue Beth Israel - The West Temple Cedar Sinai Synagogue Chabad of Beachwood Chabad of Cleveland Cleveland Hebrew School Cleveland Torah Center Congregation Beis Doniel Congregation Shaarey Tikvah Congregation Tiferes Avigdor Duplicate Froimovitz Chabad Green Road Synagogue Heights Jewish Center Jewish Education Center Jewish Family Experience Jewish Learning Connection K'hal Yereim Kehillas Bnai Torah Kol Chadash Kol HaLev-Reconstructionist Havurah Kollel Yad Chaim Mordechai Oheb Zedek Cedar Sinai Synagogue Ohel Sarah Park Synagogue Semach Sedek Shomre Shabbos Solon Chabad Suburban Temple-Kol Ami Taylor Road Synagogue TBS Telshe Yeshiva Temple B'nai Abraham Temple Beth Shalom Temple Emanu El Temple Israel Ner Tamid The Aleksander Shul The Niggun Minyan The Sephardic Congregation of Cleveland The Shul The Temple-Tifereth Israel Torah L.I.F.E. Institute Torah U'tefilah Unaffiliated Warrensville Center Synagogue Waxman Chabad Center Young Israel of Greater Cleveland Zecher Asher Zelig Zichron Chaim Select Denomination #N/A Conservative Jewish/Non-Denominational Orthodox Other Reconstructionist Reform JEWISH EDUCATION (synagogue, day school etc.) JEWISH YOUTH GROUP OTHER JEWISH INVOLVEMENT OR ACTIVITIES HAVE YOU RECEIVED ANY PREVIOUS GRANT(S) FROM THE JEWISH EDUCATION CENTER? DID YOU PARTICIPATE IN A GIFT OF ISRAEL No Yes why not? 1st Trip to Israel 2nd Trip to Israel LIST OF PREVIOUS TRIPS TO ISRAEL (include family and organization trips, length, purpose and time) 500 Max length PLEASE LIST REFERENCES (teacher, rabbi, youth group advisor, etc.- not a relative) NAME RELATIONSHIP EMAIL PHONE NAME RELATIONSHIP EMAIL PHONE APPLICANT STATEMENT (MANDATORY) PLEASE STATE BRIEFLY WHY YOU WANT TO PARTICIPATE IN THE PROGRAM AND WHAT YOU HOPE TO DERIVE FROM YOUR EXPERIENCE. 1000 Max length FINANCIAL INFORMATION Make sure you fill in every blank space. For those monetary questions that you have no dollar amount to provide, please add a 0 as a place holder. For those written responses that you have no answer to provide; please add N/A [Not Applicable] as a place holder. EXPENSES COST OF PROGRAM $ COST OF TRAVEL (if not included above) $ TOTAL EXPENSES $ RESOURCES AMOUNT PROVIDED BY APPLICANT $ AMOUNT PROVIDED BY FAMILY (not including Gift of Israel Funds) $ GRANTS FROM OTHER SOURCES (Specify which have been confirmed and which you have applied for) $ A GIFT OF ISRAEL AMOUNTS: FAMILY SCHOOL JCF $ TOTAL RESOURCES $ AMOUNT OF FINANCIAL AID REQUESTED $ PARENT/GUARDIAN STATEMENT (MANDATORY) REASON FOR REQUEST OF AID (note extenuating circumstances and/or unusual expenses). 1000 Max length PART II -----APPLICANT FINANCIAL STATEMENT This information will be held strictly confidential and will be used by the JEC’s Financial Aid Committee only. Names will be withheld. APPLICANT’S NAME PHONE ADDRESS ZIP FAMILY INFORMATION This information will be held strictly confidential and will be used by the JEC’s Financial Aid Committee only. Names will be withheld. Parent/Guardian 1 Full Name Occupation Company/Organization Name Company/Organization Address Position or Title Self-employed Parent/Guardian 2 Full Name Occupation Company/Organization Name Company/Organization Address Position or Title Self-employed PLEASE LIST COST OF PRIVATE/DAY SCHOOL/COLLEGE TUITION AND SUPPORT FOR APPLICANT AND SIBLINGS (if applicable) Not Applicable NAME AGE SCHOOL FULL TUITION ROOM & BOARD FINANCIAL AID AMT. OF PARENTAL SUPPORT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Number of children at home Number of children away at school APPLICANT OR PARENT/GUARDIAN ASSETS/LIABILITIES Combined Gross Income (Please check one) $0-75,000 $75,001-100,000 over $100,001 Please Check any one Gross Income. Number of Dependents ASSETS READY CASH IN BANK (INCLUDE VALUE OF CDS) $ INVESTMENTS - BONDS & STOCKS (NON-RETIREMENT) $ CURRENT MARKET VALUES OF HOME(S) OWNED $ OTHER ASSETS, IF APPLICABLE, SUCH AS: RENTAL PROPERTY (CURRENT MARKET VALUE), ETC (PLEASE SPECIFY) $ TOTAL ASSETS $ LIABILITIES LOAN BALANCE (NON-MORTGAGE). SPECIFY TYPE OF LOAN: $ LOAN BALANCE (NON-MORTGAGE). SPECIFY TYPE OF LOAN: $ LOAN ON 401k, 403b OR LIFE INSURANCE $ TOTAL BALANCE DUE ON MORTGAGE $ CREDIT CARD BALANCE (UPLOAD STATEMENT IF BALANCE EXCEEDS $20,000) $ TOTAL LIABILITIES $ ANNUAL INCOME NET BUSINESS INCOME (STATE SOURCE) $ SALARIES AND WAGES – GROSS (INCLUDE COMMISSION) $ GROSS RENTAL INCOME $ UNEMPLOYMENT/FOOD STAMPS/DISABILITY $ CAPITAL DISTRIBUTIONS FROM FAMILY OR OTHER TRUSTS $ NON-RETIREMENT INVESTMENT INCOME (DIVIDENDS, INTEREST) $ ALIMONY OR CHILD SUPPORT INCOME $ OTHER INCOME (STATE SOURCES) $ ANNUAL INCOME $ ANNUAL EXPENSES ANNUAL MORTGAGE PAYMENTS $ ANNUAL CAR PAYMENTS (INCLUDE YEAR/MAKE/ MODEL) Leased Owned #1 AUTO / / $ Leased Owned #2 AUTO / / $ ANNUAL OTHER LOAN PAYMENTS (E.G. STUDENT LOANS, HOME EQUITY) TYPE $ TYPE $ ANNUAL RENT (IF HOME NOT OWNED) $ TUITION PAYMENTS $ CREDIT CARD PAYMENTS $ ALIMONY OR CHILD SUPPORT PAYMENTS $ MEDICAL EXPENSES NOT COVERED BY INSURANCE $ OTHER MAJOR EXPENSES NOT LISTED ABOVE (PLEASE SPECIFY) $ ANNUAL EXPENSES $ Please Upload Tax Document Additional Information [optional] 1000 Max length Make sure you fill in every blank space. For those monetary questions that you have no dollar amount to provide, please add a 0 as a place holder. For those written responses that you have no answer to provide; please add N/A [Not Applicable] as a place holder. I acknowledge and will comply with the information presented in the agreement . Additionally, to the best of my knowledge, I have completed the application with accurate information. 1% Complete Application Update Status View Documents Close Processing Application may take a few moments to submit. Please keep browser window open until the confirmation screen loads.