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Pollock Youth Scholarship Fund Application
Please verify reCaptcha before submitting the form.
The Pollock Youth Scholarship Fund provides scholarships for our youth to travel to Israel, attend Jewish camps, attend SLJ and NFTY retreats and SLJ school trips.
Basic Information
Are you a member of CBI?
Please Select One
Yes
No
Sorry, but at this time this opportunity is exclusive to CBI Members.
If you would like to enjoy the privileges of membership, please contact Minda Shaiman via email at
minda@cbiboca.or
g or at 561.241.8118 for more information.
Student Information
*
Student's Name
*
Student's Secular School
*
Student's Grade
*
Program applying for:
*
Date of Program
*
Total Program Cost $
*
How much financial assistance are you requesting?
Parent 1 Information
*
First Name
*
Last Name
*
Email Address
*
Mobile Phone
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
ZIP
*
Employer
*
Occupation
*
Annual Income
Is there a second parent?
Please Select One
Yes
No
Parent 2 Information
*
First Name
*
Last Name
*
Email Address
*
Mobile Phone
*
Address
if different from parent 1
*
City
if different from parent 1
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
if different from parent 1
*
ZIP
if different from parent 1
*
Employer
*
Occupation
*
Annual Income
Additonal Information
Have you been a volunteer at CBI/SLJ/NCECE?
Please Select One
Yes
No
How have you volunteered?
Are you willing to volunteer your time to CBI/SLJ activities?
Please Select One
Yes
No
In what areas of CBI would you like to volunteer?
Has the student been a Teaching Assistant in the SLJ?
Please Select One
Yes
No
Has the student previously received scholarship funds from CBI?
Please Select One
Yes
No
When and which program?
What was the amount of the scholarship received $?
Has the student received and/or applied for financial assistance elsewhere?
Please Select One
Yes
No
Where and how much was awarded $
Please explain the circumstances that have led you to apply for a scholarship
Sun, September 28 2025 6 Tishrei 5786
