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FA 2020-2021

 Congregation Beth Chaim
Confidential Application for Financial Assistance
Fiscal Year: July 1, 2020 to June 30, 2021
 

 

Please click each relevant section.

Adult 1 - Yes
Adult 2 - Yes

I/We declare that to the best of my/our knowledge, the information reported in this form is correct and complete. The Financial Assistance Committee of Congregation Beth Chaim has my/our permission to verify the information reported.

Employment Information

Employment Information

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Monthly Income (if applicable)

Monthly Housing Expenses

Monthly Discretionary Income

Child 1

Child 2

Child 3

Please make a good-faith payment to your ability while determination is made by the FA committee. Thank you.

Optional:

Yes
No
Yes
No

The Financial Secretary will honor these requests throughout this application process.

2019 W-2s
Most recent paystub

Mail to:
Financial Secretary, Personal & Confidential
c/o Congregation Beth Chaim
329 Village Road East
Princeton Junction, NJ 08550

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

  

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.
Total: