RSY-Netzer (Summer Event) Bursary Application Form 2022/5782

RSY-Netzer Bursary (Summer Event) Application Form

2022/5782
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. This form should take approximately 20 minutes to complete.

Rather than complete the form in one go, you may wish to use the Save button at the bottom of the application to save your progress and resume another time.

Deadline for Financial Assistance is the 15 April 2022.

After this date we cannot guarantee Financial Assistance.
RSY-Netzer provides financial assistance for all 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 or April Herbert on 020 8349 5662, to arrange your payment scheme. Final payment must be received no later than 3 months after the event. We prefer payment by bank transfer. Please note we can no longer accept post-dated cheques or cash.

2. Bursaries - Bursaries are available to enable more people to have the opportunity to take part in RSY-Netzer events. Reform Judaism works hard to provide bursaries from a dedicated Financial Assistance Fund. 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.

Please note: your name and details will be kept completely confidential, and only shared with the Financial Assistance Committee and Administrator. Your synagogue will not be contacted unless you give us permission to do so.
Pricing table - Shemesh 2022

	Shachar, Emunah, Reut, Atid	Briyah
*Earlybird Reform member price**	£1217	£734
Standard Reform member price	£1259	£776
Non-Reform synagogue members	£1437	£912

* Earlybird pricing applies to applications up to and including 6th February 2022

Are you Reform Synagogue members? *

Yes No
Have you applied for Earlybird pricing? *

Yes No
How many children have you applied for? *
Which camps?

Select number of children attending camp
Shachar, Emunah, Reut, Atid (Reform - Earlybird)
Briyah - (Reform - Earlybird)
Shachar, Emunah, Reut, Atid (Reform - no Earlybird)
Briyah (Reform - no Earlybird)
Shachar, Emunah, Reut, Atid (non-Reform)
Briyah (non-Reform)
Children details
Child 1 name *

First Name Last Name
Select camp that child 1 is attending *
Child 2 name

First Name Last Name
Select camp that child 2 is attending
Child 3 name

First Name Last Name
Select camp that child 3 is attending
Have you paid the full (£500) deposit on your Enrolment Form? *

Yes No
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 *

Clear
Date *

Day Month Year
Date
Section 2. Personal Details
Parent/Guardian I (person filling out this form) *

First Name Last Name
Please tick your appropriate status *
Address *

Street Address

Street Address Line 2

City County

Post Code
Email *
example@example.com
Phone Number *

Area Code Phone Number
Occupation
Parent/Guardian II (if applicable)

First Name Last Name
Address (if different from above)

Street Address

Street Address Line 2

City County

Postal code
Email
example@example.com
Occupation
Phone Number

Area Code Phone Number
If divorced or separated, please confirm which parent will be responsible for the final settlement of the account

Parent/Guardian I Parent/Guardian II
Does your family (named above) belong to a synagogue? *
If Yes, which one?
Section 3. A little bit about your child/ren
Has your child/ren been involved in RSY-Netzer before? *

Yes No
Camp/Activities Name of camp Year
Camp/Activities Name Year
Camp/Activities Name Year
Number of child/ren/dependants you have at home and are they participating on another camp/activity this year?
Section 4. Family Financial Details

We do appreciate that this may be a difficult section to complete, but it is necessary. We want to reassure you that the information on this application is kept private and confidential. Incomplete forms will not be considered. Please fill out the tables below with your financial information.

INCOME (Monthly) Net of Tax

	£
Parent 1 income
Parent 2 income
Rental income
Income support
Sickness/Disability
Child Benefit
Family Credit
Housing Benefit
Maintenance (from other parent)
Pensions
Interest/savings/shares
Grants or Bursaries
Other

Total Income CALC (HIDDEN)
Total Monthly Income (in £)

EXPENDITURE (Monthly)

	£
Rent/Mortgage
Council Tax
Water
Electricity
Gas
Insurance/pensions
Fares/Travel
Household (food/laundry)
Clothing
School meals
Child minding
Loans/credit commitments
Telephone
Synagogue fees
School fees (inc tutors and music lessons)
Other

Total Expenditure CALC (HIDDEN)
Total Monthly Expenditure (in £)
Please list the value of all assets and liabilities

Assets

	£
Owner Occupied property
Rental Property
Stocks, shares & bonds
Cash in Bank & building society
Other (please elaborate in box below)

Total Assets CALC (HIDDEN)
Use this space for other (if required)

Liabilities

	£
Mortgage
Credit/debit cards/store cards
HP/Loans
Other (elaborate in box below)

Total Liabilities CALC (HIDDEN)
Use this space for other (if required)
Contribution from other family members. Would any other member of your family (e.g. ex-spouse, grandparents, aunts/uncles) be prepared to contribute?

Yes No
Please tell us in under 400 words why you are applying for Financial Assistance *

0/400
Have you approached your Reform synagogue for Financial help?

Yes No
Would you like MRJ to approach your Reform synagogue?

Yes No
Upload your latest P60.

Cancel of
Upload 3 months of current payslips. You may upload multiple files.

Payslips must be within the last 6 months
Cancel of
Upload Tax return (if self-employed).

Cancel of
We are sorry that we cannot accept late applications as once our fund has been allocated it is then closed for the year. There is no cancellation charge applicable in cases where financial support is requested (by the deadline) but where the request cannot be met.
Section 5. Bursary Request
Total programme cost(s)
Enter in contribution from parent(s)
includes deposit; we will not be able to process your application if this question if left unanswered
Enter in contribution from family members
Enter in contribution from other source(s)
CALC HIDDEN: Total Financial Assistance requested
Total Financial Assistance requested
CALC HIDDEN Percentage of costs wanted (%)
Thank you for applying for financial assistance. Please submit your application and we will be in touch by email shortly.
Should be Empty:

RSY-Netzer Bursary (Summer Event) Application Form

Pricing table - Shemesh 2022

Which camps?

Children details

Section 1. Declaration

Section 2. Personal Details

Section 3. A little bit about your child/ren

Section 4. Family Financial Details

Please list the value of all assets and liabilities

Section 5. Bursary Request

Thank you for applying for financial assistance. Please submit your application and we will be in touch by email shortly.