Dues and Religious School Tuition Assistance

Request for Membership Dues & Religious School Tuition Assistance 2024-2025

כל ישראל ערבים זה בזה
“All Israel are responsible for one another”

Thank you for being a member of Temple Israel of Hollywood. Ensuring the equitable and compassionate allocation of financial support is among our highest priorities.

Please complete all information to ensure the Financial Assistance Committee can properly evaluate this request.

Our financial assistance process is done thoughtfully, with sensitivity and care. All information is held in strict confidence.

Please note the priority application deadline for Religious School tuition assistance is June 30, 2024. Requests after that date will be reviewed and considered as resources allow.

Fiscally Responsible Household Member #1

Please complete the following information regarding the fiscally responsible members of your household.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Occupation(Required)

Please indicate “retired” if you are retired or “NA” if this does not apply to you.

Employer

Phone(Required)

Email(Required)

Would you like to list another fiscally responsible adult?(Required)

Yes

No

Fiscally Responsible Household Member #2

Please complete the following information regarding the fiscally responsible members of your household.

Name(Required)

First Last

Address(Required)

Same as Household Member #1

Street Address Address Line 2 City State ZIP Code

Occupation(Required)

Please indicate “retired” if you are retired or “NA” if this does not apply to you.

Employer

Phone(Required)

Email(Required)

Would you like to list another fiscally responsible adult?(Required)

Yes

No

Fiscally Responsible Household Member #3

Please complete the following information regarding the fiscally responsible members of your household.

Name(Required)

First Last

Address(Required)

Same as Household Member #1

Street Address Address Line 2 City State ZIP Code

Occupation(Required)

Please indicate “retired” if you are retired or “NA” if this does not apply to you.

Employer

Phone(Required)

Email(Required)

Would you like to list another fiscally responsible adult?(Required)

Yes

No

Fiscally Responsible Household Member #4

Please complete the following information regarding the fiscally responsible members of your household.

Name(Required)

First Last

Address(Required)

Same as Household Member #1

Street Address Address Line 2 City State ZIP Code

Occupation(Required)

Please indicate “retired” if you are retired or “NA” if this does not apply to you.

Employer

Phone(Required)

Email(Required)

This field is hidden when viewing the form

TIOH Involvement

Membership Type(Required)

Couple

Single

Describe your involvement and the importance of membership to you and your family in the TIOH community(Required)

This field is hidden when viewing the form

Dependent Information

How many dependents do you have?(Required)

Dependent #1

Name(Required)

First Last

School(Required)

Please provide the name of your dependent’s current school, if not applicable, please enter NA

Grade in September 2024(Required)

Will this dependent be enrolled in one of our Religious School programs?(Required)

No

Yes, Religious School / Teen Program

Dependent #2

Name(Required)

First Last

School(Required)

Please provide the name of your dependent’s current school, if not applicable, please enter NA

Grade in September 2024(Required)

Will this dependent be enrolled in one of our Religious School programs?(Required)

No

Yes, Religious School / Teen Program

Dependent #3

Name(Required)

First Last

School(Required)

Please provide the name of your dependent’s current school, if not applicable, please enter NA

Grade in September 2024(Required)

Will this dependent be enrolled in one of our Religious School programs?(Required)

No

Yes, Religious School / Teen Program

Dependent #4

Name(Required)

First Last

School(Required)

Please provide the name of your dependent’s current school, if not applicable, please enter NA

Grade in September 2024(Required)

Will this dependent be enrolled in one of our Religious School programs?(Required)

No

Yes, Religious School / Teen Program

This field is hidden when viewing the form

Financial Information

Blackbaud Tuition Total(Required)

If you have a child(ren) enrolling in traditional Religious School please provide the gross membership, tuition, fees, and other costs itemized on your Blackbaud (SMART) Tuition account, otherwise please enter 0.

Please share the amount of assistance you are requesting (either a dollar amount or the percentage of your balance) and the financial circumstances we should consider when reviewing this request.(Required)

To what extent is your request a result of communal/national/global hardships (ex: recession, pandemic, industry strike)?(Required)

Please describe if you have been granted dues relief or tuition assistance in past years:(Required)

2022 Gross Family Income(Required)

2023 Gross Family Income(Required)

Housing Status(Required)

Rent

Own

This field is hidden when viewing the form

Finalize

Signature(Required)

By entering my name in the box below, I agree that the information reported on this form is accurate and complete.