2019 Jewish Community Summer Camp Scholarship Form Dear Camp Scholarship Applicants: Welcome to the 2019 Camp Scholarship year. We could not be more excited to work with you through this process. Our mission is to make the application process as easy as possible and to have one common form for everyone to use in the Minneapolis Jewish community. Please note a few things as you start the application process. Reminder of Camp Scholarship Guidelines: Please review this before completing the application. • The completed application and accompanying information must be received no later than noon on Friday, March 1, 2019. We encourage you to apply early for scholarships with limited funds. • Other scholarship-granting organizations also accept the Minneapolis Jewish Community Common Camp Scholarship Application form. o If you are choosing to apply through Minneapolis Jewish Federation (Federation), please note that Federation will only accept your application through the online portal. o If you choose to apply through Jewish Family & Children’s Services or Beth El Synagogue, they will accept applications through Federation’s online portal as well as this paper form. o If you apply through another organization that is not mentioned above, you will be able to save your application as a PDF, print it and send directly to each organization. o If sending to a camp or other organization, you are responsible for obtaining that information first hand. This common form does not provide that information for you. • Please note that some organizations may require certain pages. For example, some organizations do not ask for financial information while others require that information be submitted. Please check with each organization to ensure that you are providing them with the information they require. • Requests to Federation will be considered only if the first two pages of the most recent Federal Income Tax Return is included with the application. • The timeline for the application process is as follows: o Camp Scholarship Application Launch Date: November 1, 2018 o Camp Scholarship Application Closing Date: March 1, 2019 • Camps and families will be notified of application status no later than March 22, 2019 Should you have any questions or concerns please contact Laura Tilsner, Administrative Professional: Community Impact at [email protected] or 952-417-2348. PART A: FAMILY INFORMATION PRIMARY PARENT / GUARDIAN INFORMATION Last Name: First Name: Street Address: City: State: Zip Code: Phone Number: Email Address: Primary Parent / Guardian Employer: Please indicate current employer or whether you are not working. Primary Parent / Guardian Occupation: If none, list N/A. Primary Parent / Guardian Relationship to Camper: Marital Status: Father Single Mother Married Grandfather Domestic Partner Grandmother Divorced Legal Guardian Separated Stepfather Widowed Stepmother Other Number of People in Household: Primary Parent / Guardian Synagogue: Select all synagogues you are affiliated with from the list. Adath Jeshurun Congregation Bet Shalom Congregation Beth El Synagogue Congregation Bais Yisroel Darchei Noam Congregation Kenesseth Israel Congregation Mayim Rabim Minneapolis Chabad Center Or Emet Sharei Chesed Congregation Shir Tikvah Congregation Temple Israel None Other SECONDARY PARENT / GUARDIAN INFORMATION (if applicable) Last Name: First Name: Street Address: City: State: Zip Code: Phone Number: Email: Secondary Parent / Guardian Employer: Please indicate current employer or whether you are not working. Secondary Parent / Guardian Occupation: If none, list N/A. Secondary Guardian Synagogue: Select all synagogues you are affiliated with from the list. Adath Jeshurun Congregation Bet Shalom Congregation Beth El Synagogue Congregation Bais Yisroel Darchei Noam Congregation Kenesseth Israel Congregation Mayim Rabim Minneapolis Chabad Center Or Emet Sharei Chesed Congregation Shir Tikvah Congregation Temple Israel None Other PART B: CAMPER INFORMATION Last Name: First Name: Camper's Date of Birth: School: Entering Grade: Entering Grade as of Fall 2019. Please check with your camp or synagogue on their school grade / age requirements. For example, the Minneapolis Jewish Federation will only accept campers entering grades K-12. Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Camp Selection: Please select all camps your child plans to attend. You will have the opportunity to list the individual sessions in the following section. Agudah Midwest Bais Yisroel Camp Chi Camp Interlaken JCC Camp Olami and Summer Quest (Theater & Adventure Camp) Camp Ramah in Wisconsin Camp TEKO Herzl Camp Moshava of Wild Rose OSRUI Other If the camp you are seeking is not listed above, please contact Laura Tilsner at [email protected] or 952.417.2348. Camp Session Information - Please list all camp sessions and camp tuition in the spaces below. Please look at each camp website and write in the name of the session(s) your camper would like to attend. If you are not applying for more than one camp / camp session, mark with N/A in the additional spaces below. Camp Session Name: Camp Session Tuition: Please list the cost of the camp session tuition. NOTE: This is not applicable to transportation, trip fees or any other costs involved. Camp Session Name: Camp Session Tuition: Please list the cost of the camp session tuition. NOTE: This is not applicable to transportation, trip fees or any other costs involved. Camp Session Name: Camp Session Tuition: Please list the cost of the camp session tuition. NOTE: This is not applicable to transportation, trip fees or any other costs involved. Camp Session Name: Camp Session Tuition: Please list the cost of the camp session tuition. NOTE: This is not applicable to transportation, trip fees or any other costs involved. Camp Session Name: Camp Session Tuition: Please list the cost of the camp session tuition. NOTE: This is not applicable to transportation, trip fees or any other costs involved. TOTAL Camp Tuition: Please add up all camp session tuition and list here. Type of Camp: If you are attending both day and overnight camps, please select both. Day Camp Overnight Camp Day Camp Experience: Overnight Camp Experience: PART C: FINANCIAL ASSISTANCE REQUESTS Please enter all scholarship request amounts in the spaces below. You are encouraged and expected to apply for assistance to as many funding sources as possible. Total Scholarship Amount Requesting from Respective 2019 Camp(s): If you are requesting funds from multiple camps, please provide the total amount requested. If none requested, list "0". Total Scholarship Request Amount from Synagogue(s): If none requested, list "0". Name of Synagogue(s): Select from the list below all synagogues from which you are requesting funding. Adath Jeshurun Congregation Bet Shalom Congregation Beth El Synagogue Congregation Bais Yisroel Darchei Noam Congregation Kenesseth Israel Congregation Mayim Rabim Minneapolis Chabad Center Or Emet Sharei Chesed Congregation Shir Tikvah Congregation Temple Israel None Other Total Scholarship Request Amount from Jewish Family & Children's Service of Minneapolis: If none requested, list "0". Total Scholarship Request Amount from Minneapolis Jewish Federation: If none requested, list "0". TOTAL REQUEST AMOUNT FROM ALL SOURCES: PART D: FINANCIAL INFORMATION Adjusted Gross Annual Household Income: This amount must match what is stated on your submitted Federal Income Tax Return. Please check with your camp or synagogue to see if they require this information. $0-$9,999 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 $60,000-$69,999 $70,000-$79,999 $80,000-$89,999 $90,000-$99,999 $100,000-$109,999 $110,000-$119,999 $120,000-$129,999 $130,000 and higher Special Circumstances Narrative: To provide us with a better understanding of your request for financial assistance, please provide a brief narrative to explain your family need to apply for a camp scholarship. For instance, if you anticipate a significant change in your annual income for 2019, please indicate here. If not applicable, please indicate N/A. PART E: FINANCIAL TAX RETURN INFORMATION (if applicable) Type of Annual Tax Return: Annual Tax Return Submitted: Joint 2017 Individual 2018 FINAL STEPS Now that you have completed the application, here are the next steps: Submit your application to the correct scholarship-granting organization you are applying to via mail or in person. Each organization will let you know next steps once your application has been submitted and reviewed. Questions? Contact Laura Tilsner at [email protected] or 952-417-2348. 2019 Jewish Camp Scholarship-Granting Organization Contact Information We encourage you to apply to as many organizations as possible. Please apply to Federation, JFCS of Minneapolis, your synagogue, and your camp (as applicable). See the contact information below for community camp scholarship granting organizations. A reminder to check if organizations you are applying to accept the common camp scholarship form or use an alternative form. Organization Contact Name Contact Email Contact Phone Number Adath Jeshurun Sue Shrell Leon [email protected] (952) 215-3910 Congregation (Director of Youth Engagement) Agudah Camp Naomi Horowitz (Camp [email protected] (847) 696-6800 (Midwest) Coordinator) Bet Shalom Jill Crimmings (Rabbi) [email protected] (952) 933-8525 Congregation Beth El Synagogue Avi Olitzky (Rabbi) [email protected] (952) 873-7300 Camp