Scholarship Application - Form - Temple Beth El

Temple Beth El Confidential Scholarship Application

Thanks to a generous donation made by Temple Beth El congregants Edward Newman for Simcha, Leta Miller for Temple School and other generous donors, Temple Beth El is pleased to offer needs-based scholarship assistance towards tuition. We are committed to making Simcha Preschool, Temple School, Camp Kayetz and overnight camps accessible to all families, regardless of income. We recognize that completing this form may cause discomfort for you and your family; please know that we deeply respect your privacy and will handle all submitted forms with the highest level of confidentiality.

Since needs-based scholarship funds are limited, we encourage early submissions to ensure all requests are thoughtfully considered and as many children as possible can benefit.

Thank you for carefully completing this form which will help streamline the application process and accelerate the selection of scholarship recipients.

Please note: At this time, we are accepting applications for Simcha Preschool only. Applications for Camp are now closed, and Temple School applications will be accepted beginning in July. If you are in need of assistance for camp, please contact Rachel Polhamus: rpolhamus@tbeaptos.org or 831 713 5616.

* Child #1 First Name

* Child #1 Last Name

* Child #1 Age

Select All That Apply

Simcha PreschoolOther

* Child #2 First Name

Child #2 Last Name

* Child #2 Age

Select All That Apply

Simcha PreschoolOther

* Child #3 First Name

Child #3 Last Name

* Child #3 Age

Select All That Apply

Simcha PreschoolOther

* Primary Parent/Guardian First Name

* Primary Parent/Guardian Last Name

* Primary Parent/Guardian Phone Number

* Primary Parent/Guardian Email Address

Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian Phone Number

Secondary Parent/Guardian Email Address

What is the total monthly tuition charged by Simcha for your family?

What percentage discount does your family need for Simcha?

Dates of camp sessions

Total annual fees for camp

Total annual Financial Aid Assistance requested for camp

Please list any financial aid that you are already receiving (e.g. Family Support, CalWorks, Voucher Project, other...) and the amounts of each in the field below.

* Total combined family income from all sources

* Debt Level Amount

* Regular Monthly Expenses:

* How many adults in your household?

* How many children in your household?

If the decrease in household income is due to medical reasons, please let us know if it is for a parent or child:

ParentChild

If a parent/guardian is unemployed now, but is starting a job, please note the date the job will begin:

If Social Security has ceased, please list name and date:

Please provide a brief description of the decrease in your household income:

Please list all education expenses incurred for all members of the household including; daycare, religious school, K-12 secular education and college (please list students names and educational Institutions):

Did you incur expenses for any of the following life-cycle events this past year?

B'nai MitzvahElder-Care ExpensesFuneralWedding

If you did incur expenses for any of the above listed life-cycle events this past year, how much was this expense?

1. I certify that all the information provided in this request is true, correct and complete.
2. I authorize Temple Beth El to make whatever inquiries are deemed necessary.

* Parent/Guardian Signature:

* Date: