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Special Dues Request - Synagogue Membership

2025-2026

Please complete this form to apply for dues assistance at Valley Beth Shalom. All information submitted is kept private and confidential. If you have any questions, please don't hesitate to reach out to Karen Benyishay, VBS Sat 818-530-4018, or by email kbenyishay@vbs.org.

The Temple Special Dues Committee makes great efforts to distribute our limited funds in the fairest manner possible. Please note that scholarship awards are limited to a maximum of 50% of the total tuition cost. Payment plans are available.

Member Information
Member 1:









Member 2 (if applicable):














Child/Children Information

One Child





Two Children:
Child 1:





Child 2:





Three Children:
Child 1:





Child 2:





Child 3:





Four Children:
Child 1:





Child 2:





Child 3:





Child 4:





Income Information











Expenses
Home






Credit Cards


Vehicles

One Vehicle
Vehicle 1:



Two Vehicles
Vehicle 1:



Vehicle 2:



Three Vehicles
Vehicle 1:



Vehicle 2:



Vehicle 3:



Four Vehicles
Vehicle 1:



Vehicle 2:



Vehicle 3:



Vehicle 4:



Medical


Education



Key Assets & Liabilities



Request
Unfortunately, VBS does not have sufficient funds to fulfill all special dues requests.  The committee tries their best to help as many members as possible.  Thank you for your understanding and support!



Affirmation

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