Bursary Application Form

LJY-Netzer Bursary Application Form Short Events

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 10 minutes to complete
LJY-Netzer aims to provide 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 to provide bursaries from a dedicated Financial Assistance Fund.

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.

Each form is for one child. If you wish to fill in the form again for another child, please complete the form and use the "Fill in Again" link on the "Thank you" page.
Child's Name

First NameLast Name
Select camp that your child is attending*
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*

DayMonthYear
Date
Section 2. Personal Details
Parent/Guardian I (person filling out this form)

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Email
example@example.com
Phone Number

Area CodePhone Number
Occupation
Parent/Guardian II (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
Please tick your appropriate status*
If divorced or separated, please confirm which parent will be responsible for the final settlement of the account

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

YesNo
If yes, has your child been involved in LJY-Netzer before?
Camp/Activities Name Year
Camp/Activities Name Year
Camp/Activities Name Year
Are any of your other children participating in another camp/activity this year?

YesNo
If yes, which one?
If yes, which one?
Reason for Financial Assistance
Please could you tell us why you are applying for Financial Assistance*
Have you approached your Liberal synagogue for Financial help?

YesNo
Would you like LJY to approach your Liberal synagogue?

YesNo
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 4. Bursary request
Programme cost
Enter in contribution from parent
We will not be able to process your application if this question if left unanswered
Enter in contribution from family members
CALC: Total Financial Assistance requested
Total Financial Assistance requested (in GBP)
Thank you for applying for financial assistance, please submit your application and we will be in touch by email shortly.
Should be Empty:

LJY-Netzer Bursary Application Form Short Events

Section 1. Declaration

Section 2. Personal Details

Section 3. A little bit about your child

Reason for Financial Assistance

Section 4. Bursary request

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