Jewish Federation of New Hampshire
2010 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

Last Name:______________________________

 First Name:__________________________

Parent(s)/Guardian(s) Names:_______________________________________________________

Phone:______________________________

 Email:____________________________________

Address:_______________________________________________________________________
Town, City, State, Zip:____________________________________________________________
High School Currently Attending:_______________________________________________
Syagogue Affiliation:________________________________________________________
_____ 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 ____________________________________________.
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 and that the teen is required to participate in a three-session “Israel Study” program offered by JFNH.

_____________________________________________
Signature of Teen

 __________________
Date

_____________________________________________
Signature of Parent

 __________________
Date