Bob Goldman Scholarship Application

Applicant's Name

Attach scanned copy of acceptance

NOTICE: Applicant's acceptance into the program must follow or accompany this application. Mail to: Congregation Etz Chaim, Attn: Bob Goldman Scholarship Coordinator, 1190 Indian Hills Pkwy, Marietta, GA 30068

Address

City

State

Zip

Email Address

Student's Preferred Contact #

Date of Birth

School Attending

Grade

Name of Program

Sponsoring Organization

Full Address of Sponsoring Organization

Date of Departure

Length of Program

Cost of Program

Attach a brief essay explaining what you expect to gain from the program you will be attending.

Applicant's Signature

Parent's Signature

Please Note:
After submitting, you will receive a confirmation. Additionally, you will receive a copy of your application at the email address given in your application.

Within a week, you will receive confirmation of your application's receipt by Richard Smith or Bob Gordon, the Goldman Scholarship Coordinators.

Applications must be received by May 1st of the current calendar year.

Sat, July 27 2024 21 Tammuz 5784



kROGER pURCHASES BENEFIT eTZ cHAIM
1190 INDIAN HILLS PARKWAY MARIETTA, GA 30068 MAIN: 770.973.0137 \| EDUCATION: 770.977.3384 FAX: 770.977.0829 REFUND POLICY: FOR BILLING DISCREPANCIES OR QUESTIONS, PLEASE CALL