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Yad Menachem Scholarship Application
Mother
First Name
*
Gender
Female
Last Name
*
Street Address
*
Address Line 2
City
*
Postal Code
*
State/Province
*
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Phone Number
*
Email
*
Parents marital status
Parents are married
Father
Gender
Male
First Name
*
Last Name
*
Street Address
Address Line 2
City
Postal Code
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Phone Number
Email
*
Relationship between parents
- None -
Married
Divorced
How many kids are you applying for?
*
1
2
3
4
Child 1
First Name
*
Last Name
*
Address
*
- Select -
Use the same address as Mother
Use the same address as Father
Birth Date
*
Month
Month
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2015
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2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
*
- Select -
Boy
Girl
Current School
*
Jewish school you want to apply to
*
Requested tuition amount for this child (after all school discounts and outside scholarships)
*
Maximum amount you can pay (for this child)
*
Child 2
First Name
*
Last Name
*
Address
*
- Select -
Use the same address as Mother
Use the same address as Father
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
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Year
Year
1925
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2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
*
- Select -
Boy
Girl
Current School
*
Jewish school you want to apply to
*
Requested tuition amount for this child (after all school discounts and outside scholarships)
*
Maximum amount you can pay (for this child)
*
Child 3
First Name
*
Last Name
*
Address
*
- Select -
Use the same address as Mother
Use the same address as Father
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
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31
Year
Year
1925
1926
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1929
1930
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1932
1933
1934
1935
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1941
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1981
1982
1983
1984
1985
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1987
1988
1989
1990
1991
1992
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1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
*
- Select -
Boy
Girl
Current School
*
Jewish school you want to apply to
*
Requested tuition amount for this child (after all school discounts and outside scholarships)
*
Maximum amount you can pay (for this child)
*
Child 4
First Name
*
Last Name
*
Address
*
- Select -
Use the same address as Mother
Use the same address as Father
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
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10
11
12
13
14
15
16
17
18
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20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
*
- Select -
Boy
Girl
Current School
*
Jewish school you want to apply to
*
Requested tuition amount for this child (after all school discounts and outside scholarships)
*
Maximum amount you can pay (for this child)
*
Any Additional school age children? (Prescool-12)
There are more school age children (Kindergarten-12th grade) in the family that i'm not applying for
PLEASE PROVIDE THEIR NAMES, AGES, AND SCHOOLS
Synagogue Affiliation
Synagogue you are affiliated with
*
Attending a synagogue is not a qualification for assistance, it is just for us to understand the demographic we serve and your needs. You can write not affiliated if you do not regularly attend a synagogue.
Synagogue Contact Name
Name of the synagogue's Rabbi, or any other reference.
Synagogue Contact Phone
Phone of the synagogue's Rabbi, or any other reference. (Numbers only! no spaces or dashes etc.)
Household Financials
Why you request financial assistance
*
Yad Menachem is happy to help anyone who feels they need assistance to afford Jewish day school tuition provided they are first approved for financial aid at the school of their choice. If there is a challenge getting financial aid from the school we can at times be of assistance in speaking to the school on your behalf.
Yad Menachem
RabbiWagshul@gmail.com
|
917-225-3558
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