The Richard Cohen Memorial Scholarship Fund was founded with a goal of providing qualifying teenagers the opportunity to participate in the JCC Maccabi Games. Rich had a passion for basketball and in the late 90s and early 2000s, as both a player and a coach, the JCC Maccabi games allowed him to do what he loved, while creating lifelong bonds and memories. Rich lost his battle to colon cancer in 2020, but wanted to ensure that other passionate teenagers were provided the necessary means to play in the JCC Maccabi Games.

Confidential Request For Sholarship

JCC Maccabi Participant Name *

JCC Maccabi Participant Sport *

Applicant Name *

Relationship to JCC Maccabi Participant *

Applicant phone number *

Applicant email *

Street Address *

Address Line 2

City *

State

Zip Code *

Country (If not US)

Own or Rent? *

Own

Rent

Other Other

Employer *

Job Title *

How long have you worked there? *

Employers address *

Employers phone number *

Gross Income *

Income verified? *

Yes

Other Income *

Source of other income *

Marital Status *

Married

Divorced

Separated

Widowed

How Long? *

Spouses Name *

Spouses Employer *

How long have they worked there? *

Gross Income *

Employers Phone Number *

Other Dependents

Name

Age

Name

Age

Name

Age

Name

Age

Other adults living in your household

Additional Information

Name of Bank *

Bank address *

Automobile(s) Type *

Monthly car payment(s) *

Other Expenses

Support of other relatives

Medical

Special Education

Other unusual expenses

Total unusual expenses

All monthly payments total *

What is the total amount you feel you can pay for this program? *

Will you require a payment plan to meet your obligation? *

Yes

Are you seeking other funding besides this scholarship? *

Yes

Which other sources are you exploring? (Check all that apply) *

I hereby state that the information shown hereon is accurate.

Signed *

clear

Date * +

Additional Attachments Required

Please attach the following:

Most recent completed Federal Income Tax Return
Most recent paycheck stub(s)
A letter explaining any extenuating circumstances if applicable
A letter from the JCC Maccabi participant explaining why this is important to them

If you are unable to attach the above electronically please email jccmaccabi@jcca.org for fax or mail instructions.

Upload Attachments Here

I hereby state that the information attached hereon is accurate.

Signed *

clear

Date * +