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Copy of Mini-form FA 2021-2022

 Congregation Beth Chaim
Confidential Application for Financial Assistance
Fiscal Year: July 1, 2021 to June 30, 2022


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.

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



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

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.