Scholarship

Title*

Name*

First Last

Hebrew Name*

Current Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Please enter in format (###)###-####

Cell Phone*

Please enter in format (###)###-####

Email*

Enter Email Confirm Email

Age*

Date of Birth*

Marital Status*

Single

Married

Divorced

Separated

Father's name & phone number*

Mother's name & phone number*

Emergency Contact*

Emergency Contact Phone Number*

Relationship*

How long do you plan to attend Machon Chana?*

One semester

One year

Other

If other, how long do you plan to attend Machon Chana?*

Do you plan to attend Machon Chana:*

Full Time

Part Time

Financial Aid Section

Please note: All financial agreements must be approved by the Machon Chana financial office before student attends classes. Full-time tuition is $6,000 (Sept.-June). Summer will be billed separately. Housing is $6,600 (Sept.-Aug.). All payments are due by the 1st of the month. Did you receive parental support during the last 12 months? (Including money, clothes, food, car, medical and dental care, loans, travel, college fees etc.)

Did you receive parental support during the last 12 months? (Including money, clothes, food, car, medical and dental care, loans, travel, college fees etc.)*

yes

Do you expect parental support in the next 12 months? (Including money, clothes, food, car, medical and dental care, loans, travel, school fees etc.)*

yes

Student's total income from work (last 12 months)*

Student's non-work income (last 12 months)*

Including social security, benefits, interest, alimony

Student's total savings and assets*

including stocks, CD's, mutual funds, real estate

Expected take-home monthly income while attending Machon Chana*

How much can you commit to pay per month?*

Full-time tuition is $6,000 (Sept.-June). Summer will be billed separately. Housing is $6,600 (Sept.-Aug.).

Explain any special circumstance you feel the school should consider in assessing financial need and award eligibility.

For the purpose of showing scholarship donors your application:

I agree to write up and sign a brief description of how I would like to learn, and why I cannot afford to pay fully.*

yes

I agree to write and sign a personal thank you letter to the donor.*

yes

I certify that all the information given on this form is true and accurate to the best of my knowledge and that, if requested, I will furnish proof of submitted data.*

I agree

Applicant's signature & Date*

For Registrar use only:

School year

# of terms attending

Total Tuition Due$

Financial Award$

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Scholarship Applicaton

Financial Aid Section

For the purpose of showing scholarship donors your application:

For Registrar use only: