Application for Dues Reduction

Please send a copy of your past year 2020 Federal Income Tax Return, W-2 forms and a copy of your current year pay stub(s) to the Temple Chaverim office.


Employment Information

(Including salary, wages, bonus, commissions, etc.)
(Including salary, wages, bonus, commissions, etc.)
Applicant - Ownership Interest in Business?
Spouse/Partner - Ownership Interest in Business?

Household Financial Information

Child Support:
(including taxes and insurance)
Principal Home
(including taxes and insurance)
Secondary Home
(Insurance premiums, co-pays, out of pocket)
Car Payments
Car Make & Model
Monthly Payment
Own or Rent?

Other Planned or Committed Activities

(Country Club, Golf Club, Fitness Club)

Description of Circumstances

Please explain unusual expenditures or circumstances in detail.

Current Dues and Fees

Shown below are the dues/fees for Temple Chaverim’s Family Membership category for 2021-2022 that may be eligible for special arrangement, assuming the family’s building fund obligation is still outstanding. Other membership categories, such as Post-bar mitzvah Membership, have different basic dues obligations. In the shaded column provided, you must indicate the total amount that you can pay based upon your financial situation.

Please note: Only the following dues/fee categories are eligible for special arrangement or adjustment. Other fees (such as the Bar/Bat Mitzvah fee, Operational, Security and Utility Assessments, and School Books/Activity Fee) cannot be modified by special arrangement.
Family Dues - Amount You Can Pay
2021-2022 amount: $2,220
Single Parent Dues - Amount You Can Pay
2021-2022 amount: $1,530
2021-2022 amount: $600 (annual prorated amount)
K-2nd Grades - Amount You Can Pay
2021-2022 amount: $425
3rd-7th Grades - Amount You Can Pay
2021-2022 amount: $425
TNL (8th-12th Grades) - Amount You Can Pay
2021-2022 amount: $180

B'nai Mitzvah Pledge (if applicable)

B'nai Mitzvah Pledge
I/We agree that we will pay all fees associated with the Bar or Bat Mitzvah of our child/children (including but not limited to the b’nei mitzvah fee, havdallah fee, membership, building fund and religious school tuition reduced by any financial relief granted) in full three months prior to my child’s or children’s Bar or Bat Mitzvah ceremony.

Applicant Statement

I/We understand that, if granted, the dues reduction and/or scholarship is for one year and must be reapplied for annually.

I/We also understand that any unpaid dues and fees from previous years must be paid, and that I/we must be current in my/our dues and fees to participate in life-cycle events (such as baby naming, Bar/Bat Mitzvah, Wedding, Funeral).

I/We further understand that the members of the Dues Reduction Committee will keep my information, adjustment and payment schedule CONFIDENTIAL, and I/we agree that I/we WILL NOT DISCLOSE the details of my/our adjustment plan to other Temple members.

I/We affirm that the information in this application is correct, and I/we agree to notify the Temple Treasurer or Executive Director in the event that any financial change occurs in the information I/we have provided.

I/We agree to keep current with my/our dues and fees AS ADJUSTED, and I/we will be responsible for all prior balances with the Temple.