RSY-Netzer Provides Financial Assistance for Our Events in Two Ways

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RSY-Netzer strongly believes that our young people should have the opportunity to take part in our events and we strive to support this in every way we can.

RSY-Netzer provides financial assistance for our events in two ways:

1.  Paying in instalments - If you are unable to pay the full amount all at once, but could manage it in instalments, please call Alyson Joseph on 020 8349 5666 to arrange your payment scheme. Final payment must be received no later than 3 months after the event. We prefer payment by standing order, but can accept pre-authorised credit/debit card payments. (Please see attached form). Please note we can no longer accept post-dated cheques.

2.  Bursaries - Bursaries are available to help ensure that everyone gets the opportunity to take part in RSY-Netzer events. Reform Judaism works hard to provide bursaries from a dedicated Financial Assistance Fund.

Please note: your name and details will only be shared with the Financial Assistance Committee and the Senior Administrator and will be kept completely confidential. Your synagogue will not be contacted unless you give us permission to do so.

We understand that some families do not apply for a bursary as they are concerned about the level of financial disclosure required. This year we also will accept applications without financial details, if you would like to submit a request without disclosure, please fill out all sections excluding section 4.
Please note it is likely that only a nominal bursary will be awarded without financial disclosure.

To be considered for a higher level of bursary, please complete this form in as much detail as possible, attaching proof of earnings (copies of recent payslips, P60 or accountants report). The person completing and signing this form must be the person responsible for payment.

Section 1. Declaration

I declare that the information given in this bursary application form is a complete and true statement of our financial position.

I accept that it is a condition of any financial assistance awarded, that in the event that my child does not complete the programme, changes from the programme to another or is dismissed from the programme for which the application is made, I shall, upon request of the Awards Committee of the Bursary Fund, reimburse the full amount of the bursary awarded.

I am a person with parental responsibility for the child named above. I am the person responsible for payment of the event.

Signature: ______Printed name: ______Date:

Section 2. Personal Details

Guardian/Parent I (person filling out this form)

Name:

Address:

Post code: Email Address:

Mobile phone and home numbers:

Occupation:

Guardian/Parent II

Name:

Address:

Post code: Email Address:

Mobile phone and home numbers:

Occupation:

Which synagogue do you and the child/ren named above belong to?

Please tick the appropriate box

If divorced or separated – please confirm which parent will be responsible for the final settlement of your account –

Name of Parent: ______

Contact number: ______

Have you applied for financial assistance for youth events in the past?

Section 3. A Little bit about your child

Has your child/ren been involved in RSY-Netzer before?

Number of children/dependants you have at home: (please include their ages)

______

______

______

______

Section 4. Family Financial Details – please complete all sections.

We appreciate that this may be a difficult page to complete. We want to reassure you that information on this application will be kept private and confidential. Incomplete forms will not be considered.

Contribution from other family members Would any other member of your family (eg. Ex-spouse, grandparents, aunts/uncles) be prepared to give a contribution?

Please list the value of all assets and liabilities

Section 5. Reason for financial assistance

Reason for financial assistance Please could you tell us in approximately 400 words why you are applying for Financial Assistance? This page must be completed.

Section 6. BURSARY REQUEST

Have you approached your Reform synagogue for Financial Assistance? Yes ◘ No ◘

Would you like MRJ to approach your Reform synagogue for Financial Assistance? Yes ◘ No ◘

Please go back to page 1 and check that everything is filled out and that your application is signed, and the necessary documents are attached.

Please return all documents by post to “Alyson Joseph, Financial Assistance, RSY-Netzer, Sternberg Centre, 80 East End Road, London, N3 2SY”.

If you have any questions regarding your application, please contact Alyson Joseph on .

Please note the deadline for Financial Support Forms for summer events is 4 March 2016.

We are sorry that we cannot accept late applications as once our fund has been allocated it is then closed for the year, any request made after the deadline may therefore be unsuccessful. There is no cancellation charge applicable in cases where financial support is requested (by the deadline) but where the request cannot be met.

Section 6. Standing order mandate

Once you have been notified of your award, this form must be sent to your bank if you are repaying by standing order – MRJ can not do this for you.

To: Bank

Please set up the following Standing Order and debit my/our accounts accordingly.

Branch Address

Payee details:

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Account Name:

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Sort Code:

Account Number

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The organisation you are paying: Movement for Reform Judaism

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Sort Code: 60-08-20

Account Number: 02958139

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Amount of payment: £

Day or date of payments (eg. 1st, 15th etc):

Frequency (eg. Weekly or Monthly):

Payment Start Date:

Final payment date (or Until Further Notice):

Reference to be quoted is your child’s name and camp name:

Signature:

Date:

Please take a copy of this form. Send one copy direct to your bank and email or send a copy direct to Alyson Joseph ()

RSY-Netzer, The Sternberg Centre, 80 East End Road, London N3 2SY.

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