Please click each relevant section.
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
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:
The Financial Secretary will honor these requests throughout this application process.
Is usually located between the symbols on your check.
Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.
