Special Considerations Application 2022-2023

Special Considerations Fiscal Year: July 1, 2022 - June 30, 2023

Special Consideration Funds will be distributed on a first-come-first-serve basis. Once our Special consideration funds have been exhausted, we will no longer be able to accommodate any requests.

All information provided and all communication will be strictly confidential to protect both the family and the integrity of the Special Considerations process. We, who are entrusted with the responsibility of according financial assistance, will do so in a fair, equitable and transparent manner.

Please read the following stipulations prior to filling out the form. By "submitting" the form, you have agreed:

Special Financial Consideration applies to member dues, debt service fund, and Jewish Learning Center (JLC) Tuition. No reduction can be considered for Early Childhood Center, Sabra/Hebrew for Credit, textbooks and supplies fees, Bar/Bat Mitzvah Tutor fees.
All forms must be filled out COMPLETELY, and signed by all applicant individually in order for your application to be processed.
Invoices and monthly statements showing amounts due and due dates will be mailed or emailed to you.

* I have read the above stipulations and do hereby agree.

I have read the above stipulations and do hereby agree.

* Name:

Family member who is filling out the form.

* Today's Date

PRIMARY MEMBER INFORMATION

* First Name

* Last Name

* Marital Status

* Email

* Mobile

* Birth Date

Age:

Occupation

Employer

How many years have you been employed by this company?

SECONDARY MEMBER INFORMATION

First Name

Last Name

Email

Mobile

Birth Date

Age:

Occupation

Employer

How many years have you been employed by this company?

FAMILY INFORMATION

* Address

Apt.

* City

* State

* Zip

Home Phone
Leave blank if there is no home phone

DEPENDENT INFORMATION

Please list all of your children and/or your parents that are living in your home.

Dependent #1 Name:

Birth Date

Age:

Relationship:

Dependent #2 Name:

Birth Date

Age:

Relationship:

Dependent #3 Name:

Birth Date

Age:

Relationship:

Dependent #4 Name:

Birth Date

Age:

Relationship:

Dependent #5 Name:

Birth Date

Age:

Relationship:

* Name of Primary Applicant

Today's Date

* Please state your reasons for requesting Special Considerations.

Upload a File

You may attach any other documentation that you feel to be relevant.

SPECIAL FINANCIAL CONSIDERATION REQUEST

Section I.

Membership Category + Annual Dues

Family ($2,875): plus $500 Debt Service Fund & $299 Security = $3,674

Young Family ($1,400): plus $500 Debt Service Fund & $299 Security = $2,199

Enduring (65yrs +) Individual ($875): plus $500 Debt Service Fund & $299 Security = $1,674

Enduring (65yrs +) Couple ($1,500): plus $500 Debt Service Fund & $299 Security = $2,299

Enduring (65yrs +) Family ($1,800): plus $500 Debt Service Fund & $299 Security = $2,599

Single Parent/Individual ($1,510): plus $500 Debt Service Fund & $299 Security = $2,309

Nitzan (36 yrs & under, no children) Individual ($360): plus $299 Security = $659

Nitzan (36 yrs & under, no children) Couple ($720): plus $299 Security = $1,019

Associate ($1,715): proof of membership required, plus $299 Security =2,014

If you are applying for special considerations for membership, please choose from the drop-down menu which category you fall under:

* Membership Category (A)

Consideration Requested for Membership Dues (B)
Insert the amount you are asking to be deducted from the total amount of your membership fee.

Total amount Requesting to pay for Membership (C)
(A) - (B) = (C)

Example:
(A) Choosing Family Membership Category = $2,875
(B) Requesting - $500 off of total membership dues
(C) Write in the box above: $2,375

Section II.

Jewish Learning Center Fees

Kindergarten + 1st Grade ($1,113): Textbooks, supplies and safety kits are inclusive

2nd - 6th Grade ($1,718): Textbooks, supplies and safety kits are inclusive

Additional Costs (per child):

$36 Teaching Team Gift

If you are applying for Special Considerations for the Jewish Learning Center program, please indicate below how many children will be attending each program.

Number of Children attending JLC (A)
Kindergarten + 1st Grade ($1,113 per child)
2nd - 6th Grade ($1,718 per child)

Consideration Requested for JLC Tuition (B)
Insert the amount you are asking to be deducted from the total amount of your JLC tuition.

Total amount requesting to pay for JLC tuition (C)
(A) - (B) = (C)
Example:
(A) 1 Child in 1st Grade + 1 Child in 3rd Grade = $2,831
(B) Requesting - $1000 off of total tuition
(C) Write in the box above: $1,831

Section III.

Add Section I & Section II together to get the GRAND TOTAL.
Please add to TOTAL cost you will be paying for below.

* TOTAL AMOUNT DUE AFTER CONSIDERATION
* Subject to approval of your request. Please note that we have a certain amount of funds allocated to Special Considerations, please take that into consideration when you are requesting financial help. The funds will be distributed on a first-come-first-serve basis. Once the funds have been exhausted, we will no longer be able to accommodate any more requests. Thank you.

Fri, April 26 2024 18 Nisan 5784