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Scholarship Application Form

Felix Berkovich Memorial Scholarship Fund
CLICK HERE for a printable Scholarship Application Form
Child info:
Full Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Gender

MaleFemale
Name of current school
Grade (currently in)
Parent info:
Marital Status
Fathers Name

First Name Last Name
Fathers occupation
Fathers Income
Fathers Cell phone Number

Area Code Phone Number
Fathers E-mail
Mothers Name

First Name Last Name
Mothers occupation
Mothers Income
Mothers Cell phone Number

Area Code Phone Number
Mothers E-mail

Home Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Do you own your house or rent?

OwnRent
How much is your monthly mortgage/rent?
List any additional income, specifying source(s) and amount(s):
List other dependents of parents, including ages:
List and explain any unusual expenses that your family may have:
Please send all supportive evidence of your income, lease/mortgage, and any other applicable documents to [email protected].
How much financial help are you requesting from the Scholarship Fund?
Should be Empty:

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Camp Address

841 Ocean Parkway
Brooklyn, NY 11230
347-850-0408

Mailing Address

1383 President Street Camp Office
Brooklyn, NY 11213

Camp F.R.E.E. - Gan Israel • 347-850-0408 • 841 Ocean Parkway, Brooklyn, NY 11230

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