The Bergen Academy of Reform Judaism
BARJ
5770-5771 (2010-2011)
Financial Assistance Application
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TO THE PARENTS OR LEGAL GUARDIANS: If you are requesting financial assistance from BARJ,
please complete this application. In order to allow time for processing, we request that you complete and
return this application NO LATER THAN June 15, 2010 with a deposit of at least $400. Upon receipt of
this request, we will make financial arrangements to the best of our ability. Your request will be confirmed
in writing by the BARJ office.
Student’s Name: ____________________________ Congregational Affiliation: _______________
Address: ________________________________________________________________________
Home Phone Number: ______________________ Date of Birth: _______________________
Parent/Guardians’ Names: __________________________ Email: ________________________
Have you spoken with your Rabbi or any other congregational representative about financial assistance for BARJ
or other school programs? Please explain, including information about outcomes of these conversations.
_________________________________________________________________________________
________________________________________________________________________________
BARJ would like to extend financial support to every family who truly needs it. Therefore, we expect you to
contribute
o your child’s education. BARJ guidelines state that the family will pay at least the deposit of $400 per child. The
balance will be split between your congregation and BARJ. If you are unable to pay the total $400 deposit,
you must obtain a letter from your congregational rabbi. The letter should indicate your financial need and
your congregation’s commitment to assisting you in contributing additionally to your child’s education by paying
half of the remaining tuition.
Can you contribute more than the required $400 deposit? If so, how much? _______________
Please note that BARJ may not be able to provide scholarships to all that apply.
Are there any extenuating circumstances that BARJ should know about?
____________________________________________________________________________________
____________________________________________________________________________________
I declare that, to the best of my knowledge, the information in this form is correct and complete. BARJ has my
permission to receive and verify the information reported.
_________________________________ _______________
Signature of Parent/Guardian Date
Please mail this application with the rest of your forms to:
BARJ, 56 Ridgewood Road, Washington Township, NJ 07676
Approved By: ____________________________ Date: ____________________