THE ISRAEL EXPERIENCE GRANT
A Gift From the Jewish Federation of Omaha
to Participate in a Peer Program in Israel
The Israel Experience Incentive Grant is a one-time grant from the Jewish Federation of
Omaha for students in grades 9-12 or young adults ages 18 to 26 for an approved Israel
experience. The grant may also be used for domestic airfare for participants in any Birthright
Israel trip. Program coordination is through the Center for Jewish Life.
Eligibility requirements for the grant are listed below.
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The applicant must be a resident of the Omaha metropolitan area.
The applicant, or the applicant’s family, is a donor in good standing to the Annual
Campaign of the Jewish Federation of Omaha.
The applicant agrees to provide - within one month of return from the program - an
article and pictures of the experience for publication in the Jewish Press.
The applicant will participate in any required preparatory program.
To apply for the Israel Experience Grant, complete this application in full.
Kindly complete as a Word document and submit either a hard copy or via email.
For any questions, please call (402) 334-6445 or email mgrossman@jewishomaha.org.
All signatures required on the last page MUST be completed
or application will not be processed.
The completed application must be returned by
March 1, 2013
Please return completed application to:
The Center for Jewish Life
333 South 132 Street
Omaha, NE 68154-2198
Payment of the grant is normally made directly to the program.
If you have already paid program costs in full, please provide a statement copy
showing payment in full and you will be reimbursed directly.
(402) 334-6445 / mgrossman@jewishomaha.org
Israel Experience Grant Application – 2012-2013
Kindly complete as a Word document and submit either hard copy or via email.
Direct any questions to (402) 334-6445 or mgrossman@jewishomaha.org.
Participant
Last Name
Preferred First
Name
Participant Email
Address
Participant
First Name
M.I.
Gender
DOB
M
Age
Current Grade Level in School (if not attending school, please type N/A)
Custodial Parent(s)
Last Name
Custodial Parent(s)
First Name
Mailing Address
City
State
Home Phone
Zip
Daytime Phone
Parent Email Address
Synagogue to Which
Family Belongs
PROGRAM INFORMATION
Name of Program
Sponsoring
Organization
Program Mailing
Address for Payments
Program Phone #
Program Website
Length of Program
Session Dates
Cost of Program Tuition
$
I hereby submit this application for a Jewish Federation of Omaha Israel
Experience Grant and agree to the requirements outlined on the cover page.
X _____________________________________________
Signature of participant
________________
Date
I hereby submit this application for my child for Jewish Federation of Omaha
Israel Experience Grant and agree to the requirements outlined on the cover page.
X _____________________________________________
________________
Signature of parent or guardian (required for applicants under age 18)
Date
The completed application, with all signatures, must be submitted to the
Center for Jewish Life, 333 S. 132 Street, Omaha NE 68154-2198
-----------------------------------------------------------------------The following to be completed by the Center for Jewish Life
Annual Campaign Status
Donor? ________ Initials________ Date________
Notification to family
Initials________ Date________
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