CBI Pollock Youth Scholarship Program - Congregation B'nai Israel of Boca Raton

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Pollock Youth Scholarship Fund Application

The Pollock Youth Scholarship Fund provides scholarships for our youth to travel to Israel, attend Jewish camps, attend SLJ and NFTY retreats and SLJ school trips.

Basic Information

RequiredAre you a member of CBI?

Yes

Sorry, but at this time this opportunity is exclusive to CBI Members.*

If you would like to enjoy the privileges of membership, please contact Minda Shaiman via email at minda@cbiboca.org or at 561.241.8118 for more information.*

Youth Scholarship Form

All information will be held in strictest confidence. Please fill out the form in its entirety.*

RequiredStudent's Name *

RequiredStudent's Secular School *

RequiredStudent's Grade*

RequiredProgram applying for *

RequiredDate of Program *

RequiredTotal Program Cost*

RequiredHow much financial assistance are you requesting? *

RequiredParent/Guardian 1 Name*

RequiredAddress, City, State, Zip *

RequiredHome Phone *

RequiredCell Phone *

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email*

RequiredMarital Status *

RequiredParent/Guardian 2 Name*

RequiredAddress, City, State, Zip *

RequiredHome Phone*

RequiredCell Phone*

RequiredEmail*

RequiredWhat grade did your child begin SLJ? *

RequiredSibling Names and Grades:*

RequiredParent/Guardian 1 Occupation *

RequiredParent/Guardian 1 Employer *

RequiredParent/Guardian 2 Occupation *

RequiredParent/Guardian 2 Occupation Employer *

RequiredAnnual Family Income *

RequiredHave you been a volunteer at CBI/SLJ/NCECE? *

RequiredIf so, how have you volunteered? *

RequiredAre you willing to volunteer your time to CBI/SLJ activities? *

RequiredIf so, in what areas of CBI would you like to volunteer?*

RequiredHas the student been a Teaching Assistant in the SLJ? *

RequiredHas the student previously received scholarship funds from CBI? *

RequiredIf yes, when and which program? *

RequiredIf yes, what was the amount of the scholarship received $? *

RequiredHas the student received and/or applied for financial assistance elsewhere? *

RequiredIf yes, where and how much was awarded $? *

RequiredPlease explain the circumstances that have led you to apply for a scholarship*

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Congregation B'nai Israel
2200 Yamato Road, Boca Raton, Florida 33431
Synagogue: (561) 241 8118 | Education: (561) 241-1484
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Pollock Youth Scholarship Fund Application

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