Day Camp Scholarship Application

Project Ezrah is happy to provide small day camp scholarships to local families. The application will close on May 15th and you will be informed of our decision on or before June 1st.

Note: Please use a separate form for each child you will be applying for.

"*" indicates required fields

Do you live in Bergen County?*

Yes

Scholarships are only available for children who reside in Bergen County.

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Do you live in Bergen County?

Yes

Scholarships are only available for children who reside in Bergen County.

Child's Name (Scholarship Applicant)*

First

Last

School Child is Currently Attending*

What Camp will your Child be Attending?*

Will Your Child be Attending One or Two Sessions of Camp?*

1 Session

2 Sessions

Full Price of Camp*

Have you asked the camp for a scholarship?*

Yes

If Yes, what is your current obligation?

How much can you contribute to day camp for this child?*

Parent #1's Name*

First

Last

Parent #1's Cell Phone Number*

Parent #1's Email Address*

Parent #1's Occupation*

Parent #2's Name

First

Last

Parent #2's Cell Phone Number

Parent #2's Email Address

Parent #2's Occupation*

Home Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Total Number of Household Members Living at Home*

Names and ages of all school aged children up to the age of 18*

What camps will those children be attending?*

Total Dollar Amount Currently in your Checking Account(s)*

Total Dollar Amount Currently in your Savings Account(s)*

Total Household Monthly Take-Home (Net) Pay*

What is your monthly rent/ mortgage payment?*

What is your total annual tuition obligation for all of the children in your household?*

Name of Family Rabbi*

Phone Number or Email of Family Rabbi*

We give permission to Project Ezrah to speak with our Rabbi*

Yes

Are you receiving any other forms of assistance (ie Tomchei Shabbos, School Scholarships etc. Note: You are still likely eligible for funds, even if you do receive from other sources) If yes please explain. **

Is there anything else you would like us to know about?*

Day Camp Scholarship Application

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