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Financial Aid Application for Membership

Please complete AS MANY FIELDS AS POSSIBLE.

 

If you have any questions while filling out this form, please contact Leslie at financialaid@thejkc.org or 913-981-8878.

Please note: There will be a $25 application fee assessed upon Membership enrollment.  

Demographic Information
Head of Household Name
Head of Household Email
Marital Status
 Single
 Married
 Divorced
 Separated
 Widowed
Address
Address 2
City
State
Zip
Phone
Spouse or Domestic Partner Name
Spouse or Domestic Partner Email
Are you a member of a synagogue?
 Yes
 No
Occupation of Applicant (Business Name)
Business Address of Applicant
Occupation of Spouse or Partner (Business Name)
Business Address of Spouse or Partner
Please explain why you are applying for assistance.
Do you have children or other dependents living at your home?
 Yes
 No
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