• Confidential Financial Assistance Application

    PLEASE SUBMIT THIS FORM TO THE ACCOUNTING DEPARTMENT ALONG WITH THE FOLLOWING INFORMATION: 

    • A brief personal statement describing your need and how this JCC program or membership will benefit you
    • Most recent Federal 1040 Tax Return
    • Most recent pay or pension stub, current W-2 or 1099, and Social Security award letters if applicable.

    Program application and/or membership application must be completed prior to the Financial Assistance Application.  Applications are located on our website at https://www.lfjcc.org/.  Your application will be handled with care and confidentiality. Applications are reviewed on a monthly basis, and you will be notified of the outcome after the review is complete.  Financial assistance is intended to cover a portion of the program fees (not 100%).

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  • Applicant Information

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  • Dependents

  •       Relationship to Applicant:   Date of Birth:            Requesting Scholarship:         

  •       Relationship to Applicant:   Date of Birth:            Requesting Scholarship:         

  •       Relationship to Applicant:   Date of Birth:            Requesting Scholarship:         

  •       Relationship to Applicant:   Date of Birth:            Requesting Scholarship:         

  • Monthly Income Sources

  • Monthy Expenses

    Please include expenses that are“unusual” for your family, such as medical expenses, living expenses, or support that is given to family members who are not your legal dependents.

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  • Confirmation of Data Provided

  • Your signature below indicates that: 

    I, the undersigned, understand that the information I provide must be accurate and verifiable.  I agree to provide any additional information that the JCC reasonably requests, and to allow the JCC to make such reasonable inquiries as it deems necessary in this regard, including without limitation, to banking institutions and credit reporting agencies. 

    I understand that if any of the foregoing information is inaccurate, the JCC may take appropriate action at its sole discretion, including without limitation, the withdrawal of any Financial Assistance, and the suspension or revocation of my membership. 

    In addition, I acknowledge that in the event that my Financial Assistance is withdrawn, but my membership privileges are still extended by the JCC, I will be expected to pay the balance of the prevailing membership fee or will forfeit my membership.

    Finally, I understand that I am submitting sensitive information over a secure server and that my application will be handled with care and confidentiality.

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