Jewish Education Center of Cleveland



Gift Of Israel Application

Student

Application Date

First Name

Middle Name

Last Name

Gender
Male Female Other

SSN

Phone 1

Phone 2

Parent/Guardian 1 Full Name

Parent/Guardian 2 Full Name

Synagogue/Religious School (If Applicable)

Date of Birth

Secular School (If Applicable)

Congregation

Highschool Graduation Year

Address

City

State

Zip Code

Current Grade

Jewish Day School (If Applicable)

How would you describe yourself?

Custodian

Full Name

Maiden Name of Custodian's Mother

Driver License Number

Driver License Issue Date

Driver License Expire Date

Driver License State

Employer

Occupation

SSN

Date of Birth

Custodian Address Same as Student

Address

City

State

Zip Code

Custodian Phone Number

Credit Card Information

Credit Card Type

Credit Card Provider

Expiration Date

First 6 Digits

A GIFT OF ISRAEL, administered by the Jewish Education Center of Cleveland,
is supported by the Fund for the Jewish Future of the Jewish Federation of Cleveland.

Success