Financial Aid Request Form for National Retreat – Due Dec. 1, 2015

Dec 1, 2014 | East Coast Events, Events

Request for Financial Assistance

Eshel National Retreat 2016

Timeline for applying for financial aid:

1. Send in Financial Aid form below by December 1st for priority consideration.

2. Financial Aid awards will be sent within two weeks.  If you apply after the priority deadline, chances of receiving aid may go down.

3. You will receive instructions and a registration code and have three days to register.  After that time the aid will be passed on to someone else.

Financial assistance is granted based on demonstrated financial need and must be evaluated for every Eshel event for which aid is being requested.  The information on this form assists us in being able to best meet your needs and our organizational needs. You may not have all of this information at your fingertips, so answer to the best of your ability.  All information is kept confidential and used only to assist in this process. Everyone will need to pay some amount to attend the retreat. We have payment plan options to make payments easier.   Please cut and paste the below into a Word document and send it to: info@eshelonline.org

  1.   Personal Information

Primary Applicant’s (adult) Name ________________________________________

Address: ____________________________________________________________

City/State/Zip: _______________________________________________________

Home Phone: ______________________ Cell Phone: ___________________

Work Phone: ______________

Email Address: ______________________________________________

Number of dependent children: _____

 

In 2-4 sentences please tell us why you would you like to attend the Shabbaton.

 

Why are you requesting aid? If you are a student, tell us about your school and what you are studying:

 

How much aid are you requesting?

 

 

Is this your first Eshel event? If not, which one(s) have you attended?

 

 

Would you be willing to volunteer or are you already volunteering at the retreat?

 

 

We need help with childcare, can you assist those doing children’s programming?

 

 

 

 

 

II. Income Source                                                   Annual/Weekly/Monthly (circle one)

  1. Gross salary – Applicant                                                                    $ ____________

Gross salary – Spouse/Partner                                                                      $ ____________

  1. Non-Salary Business Income (include rental income and tips)  $ ____________
  2.  Child Support/Alimony                                                                      $ ____________
  3. Unemployment Compensation                                                          $  ____________
  4. Other, Please Specify (parents, other relatives, etc.)                    $  ____________

Total Annual Income:                                                                             $  ____________

III. Recurring Expenses (please estimate)             Annual/Weekly/Monthly (circle one)

  1. Rent/Mortgage                                                                                       $ ____________

 

  1. Utilities (include:  Gas and electric, phone, cable, cell phone)           $ ____________
  2.  Insurance (car, home, life and health)                                                    $ ____________
  3.  Auto Payment                                                                                               $ ____________
  4.   School tuition                                                                                              $ ____________
  5.  Groceries                                                                                                       $ ____________
  6. Leisure and Entertainment (movies, theater, travel etc.)                    $ ____________
  7. Other (e.g., medical bills, loans, special needs, tutors)                        $ ____________

Total Annual Expenses:                                                                                $  ___________

  1.  Other (Describe any extraordinary expenses or special circumstances (e.g. unemployment, savings or financial support you receive.)

 

 

 

I understand that any scholarship offer must be kept confidential, and I agree to do so.  I hereby affirm that the information shown on this form is accurate.  I understand that should any information change regarding my financial circumstances I will inform Eshel staff in writing.  

Applicant’s signature:____________________________________ Date:______________________