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.
Household Financial Information
Other Planned or Committed Activities
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.
B'nai Mitzvah Pledge (if applicable)
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.