JFS Financial Assistance Application

Financial aid is made possible through the generous support of the Annual Campaign of the Jewish Federation of Omaha, endowment funds managed by the Jewish Federation of Omaha Foundation, and grants from additional philanthropic partners.

The Jewish Federation of Omaha is honored to oversee the allocation and distribution of financial assistance funds entrusted to our community. These funds are designated for the benefit of members of Omaha’s Jewish community. Our responsibility includes maintaining the utmost confidentiality for all applicants and their families, while ensuring careful and ethical stewardship of community resources.

Each year, financial assistance dollars are allocated based on need. Award decisions are determined by several factors, including the demonstrated financial need of each applicant, the total number of applications received, and the amount of funding available for distribution. Please note that all financial aid awards require a new application each year.

To apply for financial assistance through Jewish Family Service (JFS) or to request reduced Jewish Community Center (JCC) membership fees, please complete the enclosed application. In addition, please refer to the checklist on page 2 to ensure that all required documentation is submitted. Incomplete applications or missing documentation may delay processing.

Applications for reduced JCC membership for current members should be submitted by January 1, 2025.

If you have any questions regarding JFS financial assistance or reduced JCC membership, please contact:

Heather Topil
Email: htopil@jfsomaha.com

Select which one applies to you:

Young Adult (age 13-30)Individual (age 31-69)Couple (2 adults living at the same residence)Family (2 adults and dependent children under age 25 at the same residence)Single Parent Family (Unmarried parent with dependent children under age 25 at the same residence)Senior Individual (age 70 and over)Senior Couple (2 spouses with one or both at the age 70 or over)

Have you received any other assistance on campus in forms of scholarships, tuition assistance, etc.?

Total amount of assistance requested (please specify whether for rent, mortgage, or bill):

A copy of your most recent Federal Tax Return, Form 1040.Two most recent paystubs for each adult/parent listed on the application.A copy of your most recent quarterly statement from any other source of income, including but not limited to 529 Plan, IRA, Social Security, mutual fund, etc.Most recent billing statement of each expense listed on pages 5 and 6 (i.e., MUD, OPPD, insurance, cable, phone, car payments, mortgage/rent, credit card statement(s), etc.)Documentation from other sources of financial aid (i.e., synagogue, family, etc.)

Please upload ALL documents listed above:*

Please select:*

New ApplicationRenewal Application

Are you a member of the Jewish Community?*

Yes, I am JewishNo, I am not Jewish

Synagogue Affiliation

Briefly describe your household's involvement in the Jewish community.*

NAME*

EMAIL

example@example.com

ADDRESS*

CITY*

STATE*

ZIP CODE*

HOME PHONE

CELL PHONE*

WORK PHONE

AGE*

GENDER*

DATE OF BIRTH*

Date

STATUS*

MarriedDivorcedSingleWidowed

NAME

EMAIL

example@example.com

HOME PHONE

CELL PHONE

WORK PHONE

ADDRESS

CITY

STATE

ZIP CODE

AGE

GENDER

DATE OF BIRTH

Date

STATUS*

MarriedDivorcedSingleWidowed

NAME

DOB

NAME

DOB

NAME

DOB

NAME

DOB

Are you employed?*

YesNoPart-timeFull-time

NAME OF EMPLOYER

Wages Earned (Monthly)

Is your spouse employed?

YesNoPart-timeFull-time

NAME OF EMPLOYER

Wages Earned (Monthly)

Do you receive any of the following sources of income? State monthly amount received.

Social Security

Child Support

SSI

Alimony

State Assistance: SNAP, Title XX, Section 8, Medicaid, etc.

Business Income

Unemployment

Capital Gains

Checking/Savings

Real Estate

Veteran Benefits

Assistance from relatives/friends

Stocks/Mutual Funds/Bonds

Other

* If income is listed from business, capital gains, real estate or other, provide description and additional details in box below:

Total Monthly Income*

Total Yearly Income*

ADJUSTED GROSS INCOME (as listed on your Federal Tax Return)*

Household Expenses (list monthly expenses)

Mortgage/Rent*

Cable

Food*

Electric*

Gas

Water/Sewer

Trash

Phone

Internet

Taxes (if not included with mortgage payment)

Subtotal (household expenses)

Automobile (list monthly expenses)

Number of Cars*

Model(s)

Loan(s)*

Maintenance/ Repair

Gasoline

Subtotal (automobile expenses)

Insurance (list monthly expenses)

Auto

Life

Health

Homeowners/renter (if not included in mortgage payment)

Subtotal (insurance expenses)

Health (list monthly expenses)

Doctor

Dentist

Vision

Medication

Subtotal (health expenses)

Dues (list monthly expenses)

Synagogue/Temple

JCC Membership

Professional

Subtotal (dues expenses)

Fixed Debt with Interest (list monthly expenses)

Credit Cards*

Legal Obligations

Loans

Other

Subtotal (fixed debt with interest)

Child(ren) (list monthly expenses)

Preschool

Private Education

Daycare

College

Subtotal (child expenses)

Miscellaneous (list monthly expenses)

Alimony Paid

Child Support

Retirement

Savings*

Nursing Home

Other

Subtotal (miscellaneous expenses)

SUBTOTAL SUMMARY

Please refer back to your entries and enter each category's monthly expense total in dollar ammounts. Use 0 instead of N/A when the expense category doesn't apply to you.

Household*

Automobile*

Insurance*

Health*

Dues*

Fixed Debt*

Child(ren)*

Miscellaneous*

TOTAL MONTHLY HOUSEHOLD EXPENSES:*

If your monthly expenses exceed your monthly income, please explain how you are meeting the shortfall, i.e. assistance from relatives, credit card debt, etc.*

0/500

Please explain in detail the financial circumstances that you feel should be considered as your request is reviewed. You may include, but are not limited to, detailing the following: parents and/or siblings attending college; support of family member(s) outside of the immediate family; excessive educational debt; excessive medical debt; serious medical issues affecting the family; significant loss of income in the past year; single parent with little or no income from absent parent, etc. Providing the most complete information will enable the timeliest consideration of your application.*

0/1000

I attest that the foregoing information is true and correct. I understand that knowingly providing false information will deem me ineligible to receive assistance from The Jewish Federation of Omaha and its agencies.

APPLICANT SIGNATURE*

SPOUSE SIGNATURE

DATE

Date

Application for Financial Assistance

Please complete the section(s) for which you are requesting financial assistance

Requesting assistance for Jewish Community Center Membership

Requesting Jewish Family Service Financial Assistance:

DOCUMENT CHECKLIST:

PERSONAL INFORMATION

Applicant/Legal Guardian Information

Spouse Information

Children in the household

INCOME INFORMATION

EXPENSE INFORMATION