KOSHER - Camp Scholarship Application

APPLICATION NUMBER:

230422

Family Information

Family Last Name:

Address:

City:

State: New York

Zipcode:

Home Telephone:

10 digit phone number required

Email:

Valid email address is required

Does your family need a scholarship? Yes No

Are you a single parent household? Yes No

Name of Parent Completing this Application:

Cell Phone:

10 digit phone number required

Camp Information

Child 1

CHILD FIRST NAME ONLY:

Age:

Month 1

Camp Type:

Amount camp is charging you for month 1: $

Month 2

Camp Type:

Amount camp is charging you for month 2: $

CHOOSE 1 CAMP TO SEND THE TOTAL SCHOLARSHIP AMOUNT AWARDED TO YOUR FAMILY

Notes:

Date: