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Camp Gan Israel
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&#160;
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June 29th - July 17th
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			<h1 class="article-header__title js-article-title js-page-title">Scholarship Application</h1>
		
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<form class="userform-form" action="" method="post" name="form_5115645" id="5115645" accept-charset="utf-8"><input type="hidden" name="formID" value="5115645" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_1"><div id="cid_1" class="form-input-wide"> <div id="text_1" class="form-html"><p style="text-align: center;"><strong>GAN ISRAEL DAY CAMP </strong><b><br /> <strong><span>SCHOLARSHIP APPLICATION FORM</span></strong></b><span>  </span></p></div> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_25"> </label></div><div id="cid_25" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q25_fullName25[first]" id="first_25" autocomplete="given-name" />  <label class="form-sub-label" for="first_25" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q25_fullName25[last]" id="last_25" autocomplete="family-name" />  <label class="form-sub-label" for="last_25" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Child 1:<span class="form-required">*</span> </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_26" name="q26_input26" size="20" value="" /> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> Child 2: </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_27" name="q27_input27" size="20" value="" /> </div></li><li class="form-line" id="id_28"><div class="form-label-left" id="label_28"><label for="input_28"> Child 3: </label><label class="label-message" for="input_28"> </label></div><div id="cid_28" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_28" name="q28_input28" size="20" value="" /> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Are the child/ren Jewish? Please explain (mother born Jewish, conversions in family etc.)<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <textarea id="input_8" class="form-textarea validate[required]" name="q8_input8" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Dates your child/ren want to attend (the committee will try to award your family for as many weeks as possible).<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <textarea id="input_9" class="form-textarea validate[required]" name="q9_input9" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Total tuition due without discounts <span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_10" name="q10_number" style="width:100px" size="10" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_29"><div id="cid_29" class="form-input-wide"> <div id="text_29" class="form-html"><p style="text-align: center;"><a href="https://www.jewishwoodlands.com/templates/articlecco_cdo/aid/5113470/jewish/Dates-and-Rates.htm" target="_blank">(click here for rates):</a></p></div> </div></li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> How much of the tuition can you pay?  <span class="form-required">*</span> </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_11" name="q11_number11" style="width:100px" size="10" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Please explain why you cannot pay the full amount: <span class="form-required">*</span> </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <textarea id="input_13" class="form-textarea validate[required]" name="q13_input13" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> How much more would you need? <span class="form-required">*</span> </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_14" name="q14_number14" style="width:100px" size="10" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Please explain if you receive funds for camp from family and other sources: <span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <textarea id="input_15" class="form-textarea validate[required]" name="q15_input15" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> If asked to volunteer, in what are area will you be able to do so?  <span class="form-required">*</span> </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <textarea id="input_16" class="form-textarea validate[required]" name="q16_input16" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_17"><div id="cid_17" class="form-input-wide"> <div id="text_17" class="form-html"><p><span style="font-size: 16px;"><em>I attest that all information submitted on this application form is true and </em><i><br /> <em>accurate. I understand that with filling in my name, I acknowledge that </em><br /> <em>misrepresentation or omissions of material fact are grounds for disqualification. </em><br /> <em>Additionally, I will not share my scholarship amount with others.   </em></i></span><span style=""></span></p></div> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q18_fullName[first]" id="first_18" autocomplete="given-name" />  <label class="form-sub-label" for="first_18" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q18_fullName[last]" id="last_18" autocomplete="family-name" />  <label class="form-sub-label" for="last_18" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q19_phoneNumber[area]" id="input_19_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_19_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q19_phoneNumber[phone]" id="input_19_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_19_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_20" name="q20_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_21"><div id="cid_21" class="form-input-wide"> <div id="text_21" class="form-html"><p>Thank you for applying.<br /> <span>Though there are no guarantees, our hope is to have a enough resources to fund your application. Please be patient as we try to get there.  </span> </p></div> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center;" class="form-buttons-wrapper button-align-center"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="5115645" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "5115645-5115645";</script></form></div>
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