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Scholarship Application for Camp, Israel and Youth Programs

Adat Shalom’s Daniel Thursz, Camp Scholarship and Clergy Discretionary Funds.

We are delighted that your family is interested in and planning to send your child to a Jewish summer experience. Thanks to the generosity of people in our community, we have a limited amount of scholarship support to help make this more feasible. We do want to help everyone who requests but because our funds are limited, we do ask that you both seek support from other sources and also share with us below how a contribution from Adat Shalom can and will make a difference. Thank you again.

Please submit this form no later than February 18, 2021. If you have any questions or concerns, please contact Rena Milchberg.
Name of Child Seeking Scholarship:*
First Last
Current Grade in School:*
Camp / Program / Trip Name:*
Camp / Program / Trip Website:*
Dates Child will attend Camp, Trip, or Program:*
Total Cost of Camp / Trip, or Program for Child:*
Scholarship support provided by Camp, Program or Trip:*
Scholarship support provided by other agencies:*
Adat Shalom Scholarship Request:*

(Typical Range $180 - $500.)
Would you like to add another child to the application?*
- Yes
- No
Name of 2nd Child Seeking Scholarship:*
First Last
Current Grade in School for 2nd Child:*
Camp / Program / Trip Name for 2nd Child:*
Camp / Program / Trip Website for 2nd Child:*
Dates 2nd Child will attend Camp, Trip, or Program:*
Total Cost of Camp / Trip, or Program for 2nd Child:*
Scholarship support provided by Camp, Program or Trip for 2nd Child:*
Scholarship support provided by other agencies for 2nd Child:*
Adat Shalom Scholarship Request for 2nd Child:*

(Typical Range $180 - $500.)
Would you like to add a third child to the application?*
- Yes
- No
Name of 3rd Child Seeking Scholarship:*
First Last
Current Grade in School for 3rd Child:*
Camp / Program / Trip Name for 3rd Child:*
Camp / Program / Trip Website for 3rd Child:*
Dates 3rd Child will attend Camp, Trip, or Program:*
Total Cost of Camp / Trip, or Program for 3rd Child:*
Scholarship support provided by Camp, Program or Trip for 3rd Child:*
Scholarship support provided by other agencies for 3rd Child:*
Adat Shalom Scholarship Request for 3rd Child:*

(Typical Range $180 - $500.)
Member / Parent Name:*
First Last
Parents' Phone:*
Parent's Email:*
Please share with us a brief statement about how this financial assistance will help your child(ren) and family.
Write statement here:
Or upload file with statement here:
Drop files here or

Max. file size: 512 MB.