West Coast NCSY Scholarship Application
Directions:
This form must be filled out completely for consideration for financial assistance. *NO scholarship request will be considered without completed application.

Please note that you will be contacted after you have submitted your scholarship application. If you have any questions please call 310 229-9000 ext. 209

**Spring Regional Scholarship Application DEADLINE: FEBRUARY 18th, 2019**

What program do you need scholarship for? *
Student' First Name *
Please write your teen's first name.
Your answer
Student' Last Name *
Please write your teen's last name.
Your answer
Student' Home Number *
Your answer
Student' Cell Number *
Your answer
Student' Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Your Family and Community
Parent 1 Name *
Your answer
Parent 1 Occupation *
Your answer
Parent 1 Phone Number *
Your answer
Parent 2 Name
Your answer
Parent 2 Occupation
Your answer
Parent 2 Phone Number
Your answer
Marital Status of Parents *
Your answer
Synagogue / Rabbi
Your answer
School Teen Attends
Your answer
What grade is your teen in?
Your answer
Request Details
Have you discussed the possibility of financial aid with your Synagogue and/or Rabbi? If yes are they able to contribute to your child attending Spring Regional?
Your answer
What is your total family income? *
Your answer
Do you have net income or loss from business, trusts, etc: please explain
Your answer
What is your total number of dependants? *
Your answer
Please list any unusual expenses or extenuating circumstances that contribute to your need for financial aid. *
Your answer
Scholarship Amount Requested
**In order to receive any kind of scholarship assistance you and your teen will be obligated to participate in our NCSY fundraiser; we will contact you directly regarding the details.** Please note that we have many scholarship applicants and truly want to help each teen attend our event. In order for NCSY to offer you scholarship assistance we need you to submit only true and complete information which will help our scholarship committee decide how much your teen will receive. In signing this scholarship request application you are confirming that all the information is true and current.
Please provide a paragraph about the impact NCSY has had for you and your child. (Note that this may be used for PR materials. anonymously)
Your answer
Your Signature stating that all information is true and current. *
Your answer
How much do you feel the family can afford to pay? *
Please base this amount with the understanding that NCSY will need to fundraise the amount that you are unable to afford. With this information in mind please list the MOST you can pay.
Your answer
Thank you for your application: You will be contacted by the NCSY office.
NCSY Office is located at 9831 West Pico Blvd., Los Angeles, CA 90035. For more information please call: 310 229-9000 ext. 209
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