The Jewish Federation of Lane County
Scholarship Application

REVISED JANUARY 2011

Jewish Youth Experience Scholarships will financially assist and encourage young people to attend Jewish oriented conferences/events in the U.S. and in Israel.

·   Any Jewish youth age 5­–19 who resides in Lane County and is enrolled in a K–12 educational program is eligible to apply.
·   Students who wish to participate in programs that occur the summer following high school graduation will also be eligible to apply.
·   College students are not eligible for scholarships.
·   Most scholarships awarded range from $50–$200. The amount of the award is contingent on individual need, number of applicants, and availability of funds.

DUE TO LIMITED FUNDS, SCHOLARSHIPS ARE EXPRESSLY INTENDED FOR THOSE WHO COULD NOT PARTICIPATE IN A CONFERENCE OR PROGRAM WITHOUT FINANCIAL ASSISTANCE.

Please submit your application at least 3 weeks before the event/conference. No scholarship monies will be awarded without the Statement of Purpose, including a picture of the applicant. (Picture and statement may be printed in our newsletter.)

Forms must be mailed to:
Rob Stein, Chair, Education Committee
2615 Chuckanut
Eugene OR 97408

Questions: 541 485-5240
e-mail: Robstein3@gmail.com

The Follow-up Form and picture should be mailed to the Federation within 2 weeks of the event/activity.

Date_________________

Name of applicant ______________________________________

Address ______________________________________________

Phone (Home) _________________ (Cell) __________________

School __________________________ Grade ____ Age ____

What kind of Jewish experience have you had up until now? Be specific.

_____________________________________________________________

Name of conference/activity/camp _________________________________

Date of event _____________________ Location _____________________

Name of sponsoring organization ___________________________________

Costs:

• tuition:______ • transportation: _____ • lodging: ______ • food: ______

Total cost: $______

Amount of request: $_______

Is financial assistance available from the sponsoring organization? ______

Have you applied for assistance from other sources? ______

How much will you receive from the above? $_____

JEWISH FEDERATION OF LANE COUNTY: SCHOLARSHIP APPLICATION FORM: REVISED 2009 PAGE 1 OF 2

Mother’s name ______________________Occupation _______________________

Employer _______________ Work phone____________ Home phone___________

Father’s name _______________________Occupation _______________________

Employer _______________ Work phone____________ Home phone___________

Family’s annual income _______________

Parent’s marital status: married ________divorced _________separated _______

Applicant lives with _____________ How many people live in your household?_____

Other financial information which explains applicant’s need for scholarship

___________________________________________________________________

___________________________________________________________________

ALL APPLICANTS MUST COMPLETE THE STATEMENT OF PURPOSE AND THE FOLLOW-UP FORM AND PROVIDE PHOTOGRAPHS SUITABLE FOR USE IN THE FEDERATION NEWSLETTER.

By signing below, my parent/guardian and I affirm that the statements made in this application accurately reflect our situation. We agree to adhere to the guidelines for this scholarship.

Signature of applicant _________________________________________________

Signature of parent _________________________________Date _____________

ALL INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE.

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