Sinai Scholars Leadership Program

Program Grant (pending fulfillment of requirements)

Grade	Semester #1	Semester #2	Semester #3	Semester #4	Total
9th	$125.00	$125.00	$125.00	$125.00	$500.00
10th	$150.00	$150.00	$150.00	$150.00	$600.00
11th	$175.00	$175.00	$175.00	$175.00	$700.00
12th	$200.00	$200.00	$200.00	$200.00	$800.00

Grant Requirements:
• Attendance rate of 70% or higher (per semester)
• Volunteer at one (1) Friendship House event (per semester)

Full Name*

First Name Last Name

E-mail*

Phone Number*

Area Code Phone Number

Mailing Address*

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

Hebrew Name

Gender*

MaleFemale

Date of Birth*

Month Day Year

High School Attending*

What grade are you going into this coming school year of 2022/2023?*

FreshmanSophomoreJuniorSenior

Semester(s) you would like to attend:* minimum 1 semester required

Semester 1 (starting Oct 2)Semester 2 (starting Dec 4)Semester 3 (starting Feb 5)Semester 4 (starting March 26)

Fathers Name*

First Name Last Name

Fathers Cell*

Area Code Phone Number

Fathers E-mail*

Mothers Name*

First Name Last Name

Mothers Cell*

Area Code Phone Number

Mothers E-mail*

The Sinai Scholars Leadership program is proud to be partnering with the Friendship House. The Friendship House provides support to individuals with special needs and their families by providing recreational, social, and educational programming. You can learn more about the Friendship House on their website bocafriendship.com

In an effort to match you with a special friend that is most suitable for you, please complete the questions below. This is not a test – just our way of getting to know you better!

Please note: time spent at any Friendship House event can be submitted to your school as volunteer hours.

What hobbies or extra-curricular activities do you enjoy?*

I consider myself to be:*

QuietLoudAverage

Which Friendship House event(s) would you like to volunteer at in Semester #1:* Minimum 1 event per semester required

Nov 9 @ 3:30pmNov 16 @ 3:30pm

Which Friendship House event(s) would you like to volunteer at in Semester #2:* Minimum 1 event per semester required

Which Friendship House event(s) would you like to volunteer at in Semester #3:* Minimum 1 event per semester required

Which Friendship House event(s) would you like to volunteer at in Semester #4:* Minimum 1 event per semester required

May 2 @ 6:30pmMay 8 @ 6:30pm

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