Youth Scholarship Form

Congregation Rodeph Sholom Sleep Away Camp Youth Scholarship Application Form

Applications are due back by Friday, May 5th for any programs taking place in the Summer or Fall of 2023 in the US or Israel.
Submission of this form does not guarantee your receiving the full amount requested.

* Name of Applicant

* Age

Current Grade

* Parent 1 Name

* Parent 1 Phone Number

* Parent 1 Email

* Parent 2 Name

* Parent 2 Phone Number

* Parent 2 Email

* Street Address

* City

* Zip Code

* Program Applying For

Please provide the program name, sponsoring organization (if applicable), and a brief description of the program.

* Dates of Program

* Estimated Cost (excluding transportation)

* Amount I am asking for

This would be the amount remaining after subtracting any costs you are able to afford.

Eligibility Requirements for Recipient

Recipients must be active in programs and activities at Rodeph Sholom, and agree to continue their involvement after attending the program requested.
Primary member account must be in good standing.
Upon returning from their program, the recipient must work with the Education Director to express the impact of their experience and how they carry that throughout the year (Creative program, article for the website/weekly, etc.).

* Please list the programs and activities you are involved in at Rodeph Sholom

Youth Group Events, Madrichim, Religious School, volunteer programs, etc.

* In one or two paragraphs, please write why attendance at this program is important to you.

* Signature of Applicant (Please type out full name)

By requesting this scholarship, I understand that I need to be an active participant in Rodeph Sholom programs and share my experience upon return.

* How many years have you been a member at Rodeph?

* I am a member in good standing (all dues and fees paid up to date or on scheduled payment plan)

YesNo

Is there anything else you would like to tell us for consideration?

Please know that we receive a number or requests for scholarships and submission of this form is not a guarantee of the amount requested.
You will be contacted via email when a decision of award has been reached.

If you have any questions in the meantime, please contact Gary Fifer, Executive Director at director@rsholom.org or 813-837-1911

* Signature of Parent (Please type out full name)

Scholarships are only available to Rodeph member families in good financial standing.
There is no guarantee as to the amount you will receive from this fund. We do not ask for financial information, but request that if you do not truly need the scholarship, you allow those who do the opportunity to apply.
Parents of recipients are required to volunteer at Rodeph events in coordination with the Education Director, Executive Director, or Rabbi-Cantor.

* Date form submitted

Sat, April 27 2024 19 Nisan 5784