Student Scholarship Application

Student Scholarship Application
The parent(s) or guardian(s) of the child who will be attending Bader Hillel Academy should complete this form. If the parent(s) or guardian(s) are divorced, separated, or if the child has only a single parent, the parent having financial responsibility should complete this form.

Use the information from your 2022 Federal Income Tax Form (1040) when filling out this form. It is also very important to attach a copy of your 2022 Federal Income Tax Form (1040) to this application. We cannot process your application without this form. Please know that all information provided is strictly confidential.

Please fill out this application completely. If you have any questions regarding this form, please contact the school office at 414-962-9545. Thank you.
Family Last Name*

Address*

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

Preferred Phone Number*

Area Code Phone Number
*

HomeCellBusiness
E-mail*
Alternate Phone Number

Area Code Phone Number
HomeCellBusiness
Name(s) and Date(s) of birth of child/children to be attending:
Name Child 1*
Birth Date 1*

Month Day Year
Additional Children?

YesNo
Name Child 2
Birth Date 2

Month Day Year
Additional Children?

YesNo
Name Child 3
Birth Date 3

Month Day Year
Additional Children?

YesNo
Name Child 4
Birth Date 4

Month Day Year
Parent Information
Financially Responsible Parent*
Full Name*

First Name Last Name
Occupation/Title*
Employer*
How long?*
Other Parent*
Full Name*

First Name Last Name
Occupation/Title*
Employer*
How long?*
Family Information
Marital Status*
Number of adults in household*
Please enter information about the children NOT enrolled at Bader Hillel Academy
Name Child 1
School attending Child 1
Grade starting this fall Child 1
School Tuition Child 1
Scholarship Received Child 1
Additional Children?

YesNo
Name Child 2
School attending Child 2
Grade starting this fall Child 2
School Tuition Child 2
Scholarship Received Child 2
Additional Children?

YesNo
Name Child 3
School attending Child 3
Grade starting this fall Child 3
School Tuition Child 3
Scholarship Received Child 3
Additional Children?

YesNo
Name Child 4
School attending Child 4
Grade starting this fall Child 4
School Tuition Child 4
Scholarship Received Child 4
FAMILY INCOME, EXPENSES & ASSETS
INCOME
Parent*

Parent 1 Wages in 2022 Parent 1 Estimated in 2023
Other Parent*

Parent 2 Wages in 2022 Parent 2 Estimated in 2023
Dividends, interest*

Dividends Earned in 2022 Dividends Estimated in 2023
Child support*

Child Support Received in 2022 Child Support Estimated in 2023
Welfare/AFDC*

Welfare Received in 2022 Welfare Estimated in 2023
Parsonage subsidy*

Parsonage Received in 2022 Parsonage Estimated in 2023
Alimony*

Alimony Received in 2022 Alimony Estimated in 2023
Other*

Other Income in 2022 Other Estimated in 2023
EXPENSES
Mortgage/Rent*

Mortgage/Rent Paid in 2022 Mortgage/Rent Estimated in 2023
Loans*

Loans Paid in 2022 Loans Estimated in 2023
Bader Hillel Tuition for 2020*
Other (specify)*

Other Paid in 2022 Other Estimated in 2023
Other
ASSETS
Do you own your own home?

YesNo
Year & Make of Autos
Checking Account Balance
Savings Account Balance
Other
OTHER INFORMATION

Please add any additional information that should be considered in determining the scholarship. Please have documentation to support it
Additional Information
I declare that the information on this form to the best of my knowledge is true, correct and complete.
Parent Signature*
Bader Hillel Academy admits students of any race, color, and national or ethnic origin.

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Programs

Student Scholarship Application

Parent Information

Family Information

FAMILY INCOME, EXPENSES & ASSETS

OTHER INFORMATION