Jewish Federation of New Hampshire
2012 Irving and Bernice Singer
Israel Experience Grant Application

Send Completed application to: JFNH—Attn: Israel Experience Grant,
698 Beech Street, Manchester, NH 03104, (603) 627-7679, Fax: (603) 627-7963

Parent(s)/Guardian(s) Information:

Names:______________________________________________________________

Phone:___________________________ Email:_______________________________

Address:_____________________________________________________________

City, State, Zip:________________________________________________________

Synagogue Affiliation:___________________________________________________

Student's Information:

Last Name:______________________

First Name:_________________________

Phone:_________________________

Email:_____________________________

High School Currently Attending:___________________________________________

_____ I am applying for the grant of $1000.

_____ I am applying for the grant of $1800. I have continued through 10th grade or completed the high school program at the following synagogue ____________________.

Trip Information:

Name of Israel Program:________________________________________________

Dates of Trip:_______________________________________

Name of Specific Trip:_________________________________________________

Name of Trip Provider:________________________________________________

Address of Trip Provider:______________________________________________

City, State, Zip:______________________________________________________

______________________________
Contact Person

__________________________
Phone Number

We understand that the grant will be sent directly to the trip provider when the statement is submitted to the JFNH.

We also understand the following Teen Expectations:

  • To interact with the Federation shlicha (Israeli Emmissary) to orient themselves to Israel
  • To participate in the JFNH Yom Ha'Atzmaut celebration and/or complete a service project with JFNH
  • To submit an article for the NH Jewish Reporter upon their return
  • To share their experiences and promote this program by speaking at a New Hampshire Synagogue or teen event
  • To attend the JFNH Annual Meeting

__________________________________________
Signature of Teen

________________
Date

__________________________________________
Signature of Parent

________________
Date