<p>7 </p><p>RSY-NETZER BURSARY APPLICATION FORM THE MOVEMENT FOR REFORM JUDAISM (MRJ) Office Use Only: Applicant FA Code</p><p>Finances\Financial Assistance\Forms and Letters</p><p>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.</p><p>RSY-Netzer provides financial assistance for our events in two ways:</p><p>1. Bursaries - Bursaries are available to help ensure that everyone gets the opportunity to take part in RSY-Netzer events. The Movement for Reform Judaism works hard to provide bursaries from a dedicated Financial Assistance Fund. </p><p>2. 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 to arrange your payment scheme. Please note that the final payment must be received by us no later than 3 months after the event. We can accept pre- authorised credit/debit card payments, but would prefer payment by standing order. (Please see attached form). Please note we can no longer accept post-dated cheques.</p><p>Please note that your name and details will only be shared with the Financial Assistance Committee and the Senior Administrator and will be kept completely confidential.</p><p>If you would like to apply for a Financial Assistance bursary please complete this form with as much detail as possible. The person completing and signing this form must be the person responsible for payment. </p><p>Name of Camp/Event you are applying for please tick one Sheleg ◘ Kerach ◘ Machane B’Yachad ◘ Course Hadracha ◘ (school yrs 4-6) (school yrs 7-9) (school yr 10-11) (school yr 12) Name of Participant/s: ______Date of Birth:______</p><p>Section 1. DECLARATION </p><p>I declare that the information given in this bursary application form is a complete and true statement of our financial position.</p><p>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.</p><p>1 | P a g e I am a person with parental responsibility for the child named above. I am the person responsible for payment of the event. </p><p>Signature: ______Printed name: ______Date:______</p><p>Section 2. PERSONAL DETAILS </p><p>Guardian/Parent I (person filling out this form)</p><p>Name:______</p><p>Post code:______Email Address: ______</p><p>Mobile phone and home numbers:______</p><p>Occupation: ______</p><p>Guardian/Parent II</p><p>Name:______</p><p>Post code:______Email Address: ______</p><p>Mobile phone and home numbers:______</p><p>Occupation: ______</p><p>Which synagogue do you and the child/ren named above belong to?______</p><p>Section 3. A LITTLE BIT ABOUT YOUR CHILD</p><p>Has your child been involved in RSY-Netzer before? </p><p>Year Activities/camps attended</p><p>Are any of your other children participating in another camp/activity this year?</p><p>2 | P a g e Son/Daughter Organisation Activity Cost (eg. RSY) (eg. Hadracha/Tour)</p><p>Reason for financial assistance Please could you tell us why you are applying for Financial Assistance? This must be completed. </p><p>Section 4. BURSARY REQUEST </p><p>PROGRAMME COST £ Sheleg, Kerach, Machane B’Yachad & Course Hadracha Contribution from parent (we will not be able to process your application if this £ question is left unanswered)</p><p>Contribution from other family members £</p><p>Total Financial Assistance requested £</p><p>Have you approached your Reform synagogue for Financial Assistance? Yes ◘ No ◘</p><p>3 | P a g e Would you like MRJ to approach your Reform synagogue for Financial Assistance? Yes ◘ No ◘</p><p>Please return all documents by post to “Alyson Joseph, Financial Assistance, RSY-Netzer, Sternberg Centre, 80 East End Road, London, N3 2SY”. Please note the deadline for Financial Support Forms for winter event is 19th November 2017.</p><p>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 request (by the deadline) but where the request cannot be met.</p><p>4 | P a g e</p>