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Application for Dues Reduction 2023

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(Applicant)
(Spouse/Partner)
Dependents

Employment Information
(Including salary, wages, bonus, commissions, etc.)
(Including salary, wages, bonus, commissions, etc.)

Household Financial Information
If applicable
(Including taxes and insurance)
(Including taxes and insurance)
(Insurance premiums, co-pays, out of pocket)

Car Payments    Click + sign for each vehicle

Other Significant Financial Obligations

Other Planned or Committed Activities 

Description of Circumstances - Reason for requesting special consideration

Please explain unusual expenditures or circumstances in detail

Please upload a copy of your past year 2021 Federal Income Tax Return, W-2 forms and a copy of your current year pay stub(s).

Current Dues and Fees
Shown below are the various membership categories that may be eligible for a dues reduction. Please check the box of the appropriate membership category and then indicate the total amount that you can pay based on 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.  If you have previously paid a **Building fund** to Temple Chaverim or any other synagogue, please call Julie or Vicky at 516-367-6100 for information on receiving a credit on your account for the amount paid previously.
  • Annual dues: $2,335: 1st year dues $1167.50 with 50% new member incentive discount.
  • Utility/Security/Operational assessments total: $375.
  • Religious School Grades 3-7: $995 first child, $945 for additional children.
  • Religious School Grades K-2: $450 per child.
  • Books and Materials: $135 per child.
  • Tuesday Night Live (grades 8-12): $190 per child.
  • Sisterhood/Men’s Club: complimentary year one – optional dues of $36 each starting in year two.
  • Building Fund**: $3,000 – $600 per year over 5 years (years 1-5) $500 discount if paid within the first year of membership. 
  • Annual dues: $1,610:  1st year dues $805 with 50% new member incentive discount
  • Utility/Security/Operational assessments total: $375.
  • Religious School Grades 3-7: $995 1st child, $945 each additional child.
  • Religious School Grades K-2: $450.
  • Books and Materials: $135 per child.
  • Tuesday Night Live (grades 8-12): $190 per child.
  • Sisterhood/Men’s Club: complimentary year one – optional dues of $36 each starting in year two.
  • Building Fund**: $3,000 – $600 per year over 5 years (years 1-5) $500 discount if paid within the first year of membership. 
  • Annual dues: $2,025: 1st year dues $1013 with 50% new member incentive discount
  • Utility/Security/Operational assessments total: $375.
  • Tuesday Night Live (grades 8-12): $190 per child.
  • Sisterhood/Men’s Club: complimentary year one – optional dues of $36 each starting in year two.
  • Building Fund ** : $3,000 – $600 per year over 5 years (years 1-5 or years 2-6) $500 discount if paid within the first year of membership.  

B'nai Mitzvah Pledge (if applicable)

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’nai 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.
Sun, December 4 2022 10 Kislev 5783