Global Connections Financial Assistance Application 2.0

Please confirm your county of residence below.*

EssexMorrisSussexUnionParts of Somerset
Name of Israel Program*
Trip Duration*
How long does this program last?
Contact Information
Applicant Contact Information*

First NameLast Name
Email*

Confirmation EmailConfirm email address
Mobile Phone*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian 1 Contact Information*

First NameLast Name
Address is same as applicant
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Parent / Guardian 2 Contact Information

First NameLast Name
Address is same as applicant
Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.

Program Information
Program Name*
Trip Provider*
Address of Trip Provider*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Program Start Date*

MonthDayYear
Date
Date of Return*

MonthDayYear
Date
Are you in high school?*

YesNo
The Passport to Israel grant is offered to high school students who meet the following criteria:
- Live in Greater MetroWest Community
- Will participate in an approved Israel experience of at least 10 days or more duration
- Participate in educational programming as determined by grant committee
Have you applied for a Passport to Israel Grant?*

YesNo
You will receive a link to apply for a Passport to Israel grant after submitting this Financial Aid application. Please provide insight into why you haven't also applied for the Passport to Israel grant.*

Parents’ Financial Information

Please provide all information requested according to last filed income tax return.

Please upload a copy of your most recent tax return. Please redact Social Security numbers.*

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Residence
Do you own your own home?*

YesNo
Monthly Mortgage Payment:*
Do you rent:*

ApartmentHouse
Monthly Rent:*
Debts

Medical Expenses
If you had significant unreimbursed medical expenses last year or this year, or expect to have such expenses next year, please list amounts and explain.*
Please include amount of unreimbursed medical expenses.
Special Circumstances
Is there anything you think would be helpful for us to know? Please explain any special circumstances that might be of help in determining a scholarship need. Indicate any unusual expenses.*

If you did not work, please let us know how you spent your time over the summer.
V. Other Scholarship Requests
I have asked for financial assistance from:*

My synagogueMy religious schoolTrip providerI have not asked for financial assistance from other organizations / entitiesOther

Essay and Signatures
Please write a short essay that answers the following questions:
- Why do you want to go to Israel?
- What do you expect to gain from the experience?
- What do you hope to contribute to the community upon returning from the program?
I would like to type my essay into this application form directly.I prefer to upload a file for my essay.
You may write your essay here to upload a document file using the field below.*
Upload short essay*

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Signatures

Please sign below to attest to this application being true and complete to the best of you knowledge, and to authorize us to check its validity.
Applicant’s Signature*

Clear
MonthDayYear
Parent's Signature*

Clear
Date

MonthDayYear
Date
To be completed by the trip provider
This is to confirm we have received an application from:

Applicant First NameLast Name
for the following program:
Name of program
Please select one:

We provide Financial Assistance.We do not provide Financial Assistance.
Please select one:

The applicant has applied for Financial AssistanceThe applicant has not applied for Financial Assistance
Name of Program Representative

First NameLast Name
Position
Phone Number
Please enter a valid phone number.
Email

Confirmation EmailConfirm email address
Should be Empty:

	AGE	NAME OF SCHOOL	AMOUNT OF TUITION PAID BY FAMILY	AMOUNT OF LOANS / SCHOLARSHIPS
APPLICANT
SIBLING 1
SIBLING 2
SIBLING 3
SIBLING 4

	AGE	NAME OF SCHOOL	AMOUNT OF TUITION PAID BY FAMILY	AMOUNT OF LOANS / SCHOLARSHIPS
SIBLING 5
SIBLING 6
SIBLING 7
SIBLING 8
SIBLING 9
SIBLING 10

	TYPE	VALUE
DIVIDENDS / INTEREST
OTHER INCOME (Profit from business, rent royalties, trust, unemployment, compensation, social security, benefits, etc.)
ASSETS (bank accounts, money market funds, property, trust funds, CD’s, stocks, bonds, IRA tax deferred annuities, etc.)

	Name of Company or Organization	Current Position	Dates of Employment	Hours per Week	Monthly Earnings
Regular Employment
Summer Employment

Contact Information