Chabad NN Scholarship Form

A limited amount of funds are made available and are awarded based on need and in order of application.

Child's Name*

Child's Last Name*

Hebrew Name*

Birth Date*

Month Day Year

Mother's Name*

Mother's Last Name*

Mother's Cell Number*

Mother's Profession*

Was the mother born Jewish?*

YesNo

If no, please explain your families Jewish identification.

Father's Name*

Father's Last Name*

Father's Cell Number*

Father's Profession*

Was the father born Jewish?*

YesNo

Marital Status*

MarriedSeparatedDivorced

Number of children in the family*

What program is your child attending?*

Hebrew SchoolCamp Gan Israel - Full SessionCamp Gan Israel - Individual Week/s

Number of other children in the family attending the program

Are you a member of a local synagogue?*

YesNo

If yes, which synagogue are you affiliated with?

Adjusted Gross Income on 2025 Tax Return ( Line 22 on 1040 or Line 15 on 1040A)*

Scholarship* Often parents have in mind a certain amount. Please share with us a scholarship amount you are hoping to receive off your child's tuition.

Email Address*

Preferred Contact Method*

Mother's CellFather's CellEmail

Child's Information

Family Information

Contact Information