Scholarship Application 2017-18  

and Summer Gan 2017 

The Deadline for submitting a scholarship application is May 1, 2017. You will be contacted with the committees decisions after June 1st. All applications must include a copy of your 2016 tax returns. Tax returns can be faxed to (650) 493-3425 with the cover/header "GT Scholarship Committee - Confidential". They can also be scanned and emailed to gantorah@chabadgsb.com with this subject line.

Please fill out this form as accurately as possible. If you have any questions or difficulties please contact our office.

Parent #1 Information:

First Name
Last Name
Telephone Number
Employer
Job Title
City of Residence
Marital Status

Parent #2 Information:

First Name
Last Name
Employer
Job Title
City Of Residence
Marital Status

Child #1 Information:
Please fill out the following section separately for each child applying

First Name
Last Name
Date of Birth (mm/dd/yyyy)
Gender Male Female
Class  (Fall 2016)
Did you receive a scholarship for 2015? Yes No Unsure
If yes, please list amount

  Child #2 Information:

First Name
Last Name
Date of Birth (mm/dd/yyyy)
Gender Male Female
Class  (Fall 2016)
Did you receive a scholarship for 2015? Yes No Unsure
If yes, please list amount

 

Family Information:
Parent(s) claiming the applicant for tax purposes (2016 Tax returns are required). Please answer these questions as listed on your tax returns.

2016 federal tax return:  Adjusted gross income
2016 federal tax return:
Filing status
Total number of exemptions claimed (Line 6D on your 1040 returns)
# of Children in family

Reference: 
Please provide a Rabbinic or Family Reference.

Name:
Phone #:

Statement of Need:
Please describe the special circumstances that support your request for financial aid this year.

 

I am applying for: School Year 2017-18 Summer Gan 2017

Tuition Fees Information:

School Year 2017-18

Amount of full tuition
What can you pay towards school tuition?
How much can you receive from friends or family?
Please explain source
Funding from any other agencies or grants
Please explain source
Total amount requested

 

Tuition Fees Information:

Summer Gan 2017

Amount of full tuition
What can you pay towards school tuition?
How much can you receive from friends or family?
Please explain source
Funding from any other agencies or grants
Please explain source
Total amount requested

 

I confirm that all the information contained above is accurate to the best of my knowledge and I understand that if this information is found to be false I may be disqualified from receiving aid and may be required to return any funds received.

Signature  Date 
Email
(If you would like receive an email confirmation and receipt) 
 

After submitting this form, please fax a copy of your 2016 tax return to (650) 493-3425. Please include as a header: "GT Scholarship Committee - Confidential". If you do not have your 2016 returns please contact our office.

Please Note: You may be required by the committee to provide additional information including a list of assets such as Real Estate, Bank Accounts, Stocks and Bonds, Vehicles etc.