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 2023 Federal Income Tax Form (1040) when filling out this form. It is also very important to attach a copy of your 2023 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 CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Additional Children? YesNo Name Child 2 Birth Date 2 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Additional Children? YesNo Name Child 3 Birth Date 3 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Additional Children? YesNo Name Child 4 Birth Date 4 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Parent Information Financially Responsible Parent* FatherMotherOther Full Name* First Name Last Name Occupation/Title* Employer* How long?* Other Parent* FatherMotherOther Full Name* First Name Last Name Occupation/Title* Employer* How long?* Family Information Marital Status* MarriedDivorcedWidowedSingle 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 2023 Parent 1 Estimated in 2024 Other Parent* Parent 2 Wages in 2023 Parent 2 Estimated in 2024 Dividends, interest* Dividends Earned in 2023 Dividends Estimated in 2024 Child support* Child Support Received in 2023 Child Support Estimated in 2024 Welfare/AFDC* Welfare Received in 2023 Welfare Estimated in 2024 Parsonage subsidy* Parsonage Received in 2023 Parsonage Estimated in 2024 Alimony* Alimony Received in 2023 Alimony Estimated in 2024 Other* Other Income in 2023 Other Estimated in 2024 EXPENSES Mortgage/Rent* Mortgage/Rent Paid in 2023 Mortgage/Rent Estimated in 2024 Loans* Loans Paid in 2023 Loans Estimated in 2024 Bader Hillel Tuition for 2023* Other (specify)* Other Paid in 2023 Other Estimated in 2024 Other ASSETS Do you own your own home? YesNo Year & Make of Autos Checking Account Balance Savings Account Balance Other OTHER INFORMATIONPlease 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* Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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