Financial Assessment Form Beth Emet Schools & Camp 25-26

Financial Assessment Form
Beth Emet Schools and Camp
July 1, 2025 - June 30, 2026

Financial assistance request will be reviewed only when accompanied by:

1. Your most recent 1040 Tax Return and all the schedules (please cross out all social security numbers)
2. A personal letter to explain your family's situation

* Please select the program(s) in which you are applying for FA:

ECC (Early Childhood): 3 months - PreKBES (Beth Emet School): Grades K-8 (You must apply for Step Up State Scholarship before applying for FA)Summer Camp

Applicant 1

* Applicant 1: First & Last Name

* Applicant 1: Email

* Applicant 1: Cell Phone

* Applicant 1: Address

* Applicant 1: City

* Applicant 1: State

* Applicant 1: Zipcode

* Applicant 1: Occupation

* Applicant 1: Employer

* Applicant 1: Work Phone #

* Marital Status:

*If applicants are divorced we require a Financial Assessment form from both parents or an explanation why only one parent can apply.

* Please explain your divorced situation. Who has custody? Will you be spliting the payments? Any other information necessary to explain your situation.

* Relationship to Dependents:

Applicant 2

* Applicant 2: First & Last Name

* Applicant 2: Email

* Applicant 2: Cell Phone

* Applicant 2: Address if different from above

* Applicant 2: Occupation

* Applicant 2: Employer

* Applicant 2: Work Phone #

* Marital Status:

* Relationship to Dependents:

Dependents

* How many dependents?

* Dependent 1: First and Last Name

* Dependent 1: Age

* Dependent 1: School attending for 25-26

* Dependent 2: First and Last Name

* Dependent 2: Age

* Dependent 2: School attending for 25-26

* Dependent 3: First and Last Name

* Dependent 3: Age

* Dependent 3: School attending for 25-26

* Dependent 4: First and Last Name

* Dependent 4: Age

* Dependent 4: School attending for 25-26

Income (Monthly)
If a category does not apply to you please put N/A

* TOTAL MONTHLY INCOME

* Applicant 1: Salary

* Applicant 2: Salary

* Child Support

* Alimony

* Interest

* Dividends

* Tax Free Income

* If you are a business owner please describe monthly income, description of business, and do you take draws/distrbutions (that is not a salary)?

*We may contact you for further documentation.

* Other Income

Please specify where other income comes from and the amount.

Expenses (Monthly)
If a category does not apply to you please put N/A
Please list your monthly expenses in each category below.

* TOTAL MONTHLY EXPENSES

* Do you rent or own your home?

* Monthly Mortgage/Rent

* Home Owner Association Fees

* Utilities

* Food

* Insurance

* Medical

* Combined credit card monthly payment

* Total unnpaid credit card balance(s)

* Entertainment/After School Programs

* Vacation

* Auto (Gas, Insurance and Car Payment)

* Automobile Information

Please include: Make, Model and Year

* Other Expenses

Please specify other expenses and include total amount for these expenses.

Continued Information
If a category does not apply to you please put N/A

* Current Value of Cash Accounts:

* Current Value of Retirement Accounts:

* Current Value of Other Investments:

* Do you own a second home?

* What is the monthly payment and location of the home?

Continue to next question

* Do you have any other assets?

* Please list assets and their value:

Continue to next question

* Do you child(ren) attend overnight camp? If yes, which one?

* Do you child(ren) attend day camp? If yes, which one?

* Do you believe your current financial situation is temporary?

* To receive financial assitance I agree to volunteer my time, donate goods and/or solicit donations as a way of giving back to the community. Please choose all that apply.

VolunteerDonate Goods or ServicesSolicit Donations

* Based on your answer to the previous question please answer the following questions. Volunteer - What is your availability? Donate Goods & Service - What can you offer? Solicit Donations - Who can you solicit?

Payment Information
If a category does not apply to you please put N/A

* Total amount I (we) can pay for school tuition:

* Total amount I (we) can pay for school extended care, please specify AM, PM or both:

* Total amount I (we) can pay for Camp Tuition:

* Total amount I (we) can pay for camp extended care, please specify AM, PM or both.:

* I understand that Financial Adjustments are for this year only and I (we) must reapply annually.