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The Kadima Scholarship is intended to provide financial assistance for the Optimal Health Program, a comprehensive medical program that utilizes advanced testing and personalized medicine to prevent and reverse cardiovascular disease (the number one killer of both men and women). The Kadima Scholarship was created to aid those who could benefit from this type of testing and medical care, but who do not have the financial means to cover the cost of the program. 

Applications cannot be approved without submitting all the required documentation. This includes a completed application form, a copy of your most recent tax return, and a recent pay stub that contains a year-to-date income total.

Scholarships are approved for one year, to defray the expenses related to the cost of the advanced testing and treatment.  Scholarship recipients are expected to invest in their health by contributing a minimum of 10% toward the costs of the treatment provided by Kadima Center (which currently comes to $82.30 a month). Ultimately, the patient contribution will be determined by the information submitted with this application. Preference will be given to applicants based on three factors: medical need, financial need, and those in helping professions (pastors, teachers, law enforcement, charity workers, etc.) 

CONTACT INFORMATION

Name *
Date of Birth *
Address *
Mobile Phone *
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    Email *
    Occupation
     Employer
    Work Address
    Work Phone Number
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      INCOME

      Length of Employment
      Did you file a tax return for the most recent year?*
      Yes
      No
      If no, please explain:
      What is the total number of dependents living in your household (include yourself, spouse, children, and others)
      What is your GROSS FAMILY ANNUAL income?
      What is your NET FAMILY ANNUAL income?
      Other income (gifts, inheritances, savings, alimony, etc.)
      What are your average monthly family expenses (house, car, insurance, food, utilities, etc.)?
      Has your employment or income changed since your last tax return?*
      Yes
      No
      If yes, please explain:

      DESCRIPTION OF SITUATION/NEED:

      Why are you interested in the Optimal Health Program at Kadima Center? Do you have a strong family history of heart disease or stroke, or any known risk factors?
      Please describe your circumstances (i.e. medical need, debt, hardship, etc.) that would help us in considering your application for a scholarship.
      Please estimate what you can afford per month for testing and treatment at Kadima Center.

      Note:

      Applications cannot be approved without additional documentation.  This includes a completed application form, two forms of income verification – your most recent tax return and a recent pay stub that includes a year-to-date total. You may also be asked to produce other forms of income verification, such as a bank statement for the past two months, a custody agreement showing child support or alimony, and/or Social Security statements or deposits. Please note that more information may be required based on your situation. Scholarships range up to 90 percent of the costs for testing and treatment.  


      *I verify that this information is true to the best of my knowledge. I agree to let staff members at Shalom Support know if my circumstances or salary/employment status changes.
      COMPLIANCE AGREEMENT:
      As a recipient of the Kadima Scholarship, I agree to take full advantage of the Optimal Health Program by following the treatment protocols personally prescribed to me. This includes taking the prescribed medications and making the necessary lifestyle modifications. I understand that if I fail to do this, my scholarship may be revoked.
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