Personal Information

Child's Name

Date of Birth

High School

Current Grade in High School

High School Graduation Year

Address

Mobile Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Synagogue Affiliation

Trip Choice

Trip is sponsored by

Trip Name

Trip Payment Contact Representative

Trip Payment Mailing Address

Phone Number of Trip

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Cost of Trip

Departure Date

Approx. cost of Airfare to the U.S. city trip is departing from (write TBD if unsure)

Parent Information

Parent #1 Name

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Parent #2 Name

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Please indicate which parent is the primary parent for the trip

Savings & Extra Grant Funding

Do you have a savings account?

Note: In November 2017, the Federation closed all accounts at First Bank & Trust managed by the Federation and returned the funds to the respective families. Parents are now encouraged to continue to save for their child’s trip at a bank of their choosing.

Edie and Paul Gift of Israel Policies

Terms

I/We understand that the Edie & Paul Rosenblum Gift of Israel Program will make a grant of up to $7,000
available for my child’s trip to Israel in addition to $750 from my synagogue (if participating). This support is
paid directly to the trip organizer. I understand I(we) will reimburse the Jewish Federation of Greater New
Orleans for any and all funds paid by the Jewish Federation of Greater New Orleans on behalf of my child
should my child withdraw from the trip.

I, the undersigned, agree to the terms above.

Date

Additional Information

Please attach the following items to your Trip Declaration Form:

1. Israel Trip Registration Form

2. Most recent bank statement from your savings account

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Summary of grant funding that may be available towards participants of the Edie & Paul Rosenblum Gift of Israel travel:

Federation grant of $4,000
Anonymous donor gift of up to $2,500 (Not available for year-long or
semester programs – other scholarship funds may be available for these programs)
Additional Federation bonus of $500 (if participant has a savings account)
Synagogue grant of $750 (if participating)
Total scholarship funds available: $7,750

Please return the completed form to Jessie Dowsakul via email ([email protected]) or physical mail (3747 W. Esplanade Ave., Metairie, LA 70002).

Any questions? Just call, (504) 780-5614.

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