For Office Use Date Received: ____________ Amount Granted: ___________ Approved by: ______________ Parents Notified: ___________

TEMPLE BNAI TORAH YOUTH GROUP REQUEST FOR FINANCIAL ASSISTANCE

Please complete and return to the Temple Office, Attention Benjamin Judah Phelps

Dear Parents, Each year, the Youth Group Budget designates funds to provide financial assistance for families who are unable to pay the full cost of events for their children. These funds must be stretched to cover many congregants needs. To help us provide assistance to as many families as possible, we ask that whenever possible, families request no more than 50% financial assistance. Of course, if your financial situation dictates the need for a more substantial grant, every effort will be made to meet that need.

EVENT NAME: ____________________ EVENT DATE: _________

Name of Participant: Name of Participant: Name of Participant: Grade: Grade: Grade: TOTAL FEES DUE: FAMILY CONTRIBUTION (What amount if any can you pay?): Event Fee: Event Fee: Event Fee: _________

_________

FINANCIAL ASSISTANCE REQUESTED: _________

Please share any circumstances that should be taken into consideration: (Use reverse side if you need additional space):

Parents Names: ______________________ _________________________ Phone Number: _______________

Scholarship requests are due 3 days before the event registration closes. If there is an early registration deadline, the request is due 3 days before this date. All scholarships will be based on the early registration fee. You will be informed of your scholarship grant as soon as possible after a decision is rendered. If you have questions, please call the Temple office at (425) 603-9677

ALL YOUTH GROUP FINANCIAL ASSISTANCE INFORMATION IS CONFIDENTIAL.