Youth Group Financial Assistance - General Application
This application is to be submitted by each family seeking assistance at the beginning of each school year.
There will be a separate specific program application which will need to be submitted for each specific event
for which the family is asking assistance. The General application may be submitted or revised at any time
if your financial situation changes during the year but must be submitted prior to the application deadline for
the next event.

Awards are based on demonstrated financial need, and are not merit based. However, if available funds are
limited, consideration will be made based on your child’s participation and contribution to USY/Kadima.

It is expected that the family will contribute at least 33% of the cost of each program for which they are
seeking assistance and that all youth applying shall be paid members of the appropriate youth group*. If
the final award is less than you feel necessary or if the expected parent contributions unmanageable please
contact the Education Director or Scholarship Chair to consider alterative arrangements or other fund
sources. No student should be denied the ability to predicate due to financial hardship.

All Requests will be kept strictly confidential.

School year: 2017/2018

This is a revised application. Check if applicable: *
Required
Names of Children *
Your answer
Grades of Children *
Your answer
Already a USY/Kadima Paid Member? *
Parents' Name (s): *
Your answer
Address (city/state/zip): *
Your answer
Parent Preferred phone *
Your answer
Parent preferred email address *
Your answer
Check if you anticipate applying for a scholarship (can be revised)
In the space below list your children(s) involvement in their local USYChapter, Regional USY or other Jewish youth groups, Synagogue life and in the Jewish Community at large. *
Your answer
Please use one box per child and indicate which child you are filling it out for.
In the space below list your children(s) involvement in their local USYChapter, Regional USY or other Jewish youth groups, Synagogue life and in the Jewish Community at large. *
Your answer
In the space below list your children(s) involvement in their local USYChapter, Regional USY or other Jewish youth groups, Synagogue life and in the Jewish Community at large. *
Your answer
Please check one of the following. Our household income is: *
Total number of dependents: *
Your answer
Parent (s) marital status: *
Financial Need Explanation
In the space below please discuss any extraordinary circumstances, special needs, or other situations that may hinder your ability to financially support your child for these programs. (I.e. supporting aging parents, college expense, job loss, disability, medical expenses, etc.)
Your answer
I certify the information provided is accurate to the best of my ability. By writing my name below I allow it to act as my legal signature. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Temple Beth El. Report Abuse - Terms of Service