Full Bursary Application Form

LJY-Netzer Bursary Application Form

Full form version
LJY-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.

Please have to hand the total cost of the events/programmes you are requesting financial assistance for as you will need this to complete the form.

Refer to the event email / brochure for application submission deadline

For any questions, email becca@liberaljudaism.org
LJY-Netzer provides financial assistance for all our events

Bursaries are available to enable more people to have the opportunity to take part in LJY-Netzer events. Liberal Judaism works hard with its partners to provide bursaries from dedicated Financial Assistance funds.

While late applications maybe accepted (event T&Cs dependent / see cancellation charge below), once our funds have been allocated it is then closed for the year. Any request made after the deadline may therefore be unsuccessful so we suggest you apply early.

There is no cancellation charge applicable in the unlikely event that the financial assistance requested cannot be met, so long as application is received by the deadline.

Please note: your name and details will be kept completely confidential and only shared with the Financial Assistance Committee. Your synagogue will not be contacted unless you give us permission to do so.
Event and Synagogue information
Which event are you applying for?*
If you are applying for Gesharim, please use UJIA Bursary form
Other event
Does your family belong to a synagogue?*
If Yes, which one?
Are you Liberal Synagogue members?*

YesNo
Have you paid deposit(s) on the registration form (if applicable)?

YesNo
Your Personal Details
Parent/Guardian 1 (person filling out this form)*

First NameLast Name
Please tick your marital appropriate status*
Address*

Street Address

Street Address Line 2

CityCounty

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

Area CodePhone Number
Occupation
Parent/Guardian 2 (if applicable)

First NameLast Name
Address (if different from above)

Street Address

Street Address Line 2

CityCounty

Postal code
Email
example@example.com
Occupation
Phone Number

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

Parent/Guardian IParent/Guardian II
A little bit about your Child/ren
How many children have you applied for?*
Has your child/ren been involved in LJY-Netzer before?*

YesNo
Camp/Activities Name Year
Camp/Activities Name Year
Camp/Activities Name Year
Child 1 name*

First NameLast Name
Child 2 name*

First NameLast Name
Child 3 name*

First NameLast Name
Number of child/ren/dependants you have at home and are they participating on another camp/activity this year?
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/Guardian 1 income
Parent/Guardian 2 income
Property 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
Other/Rental Property
Stocks, shares & bonds
Other (please elaborate in box below)

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

Liabilities

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

Total Liabilities CALC (HIDDEN)
Use this space for other (if required)
Please tell us in under 400 words why you are applying for financial assistance:

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

YesNo
Would you like LJ to approach your Liberal synagogue?

YesNo
Upload your latest P60

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

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

Cancelof
Bursary Request
Total programme cost(s)*
Enter in full cost of all the programmes you wish to claim financial assistance for
Deposit paid
Enter deposit paid
Enter in contribution from parent(s)
Add in additional contributions in excess of deposit payment
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 (%)
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
Name*

First NameLast Name
Date*

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

On completion, you can download a copy of your application
Should be Empty:

LJY-Netzer Bursary Application Form

Event and Synagogue information

Your Personal Details

A little bit about your Child/ren

Family Financial Details

Please list the value of all assets and liabilities

Bursary Request

Declaration

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