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Dues Reduction Form

Return Form by July 1
POLICY:   No one is to be denied access to synagogue membership because of a genuine inability to pay.
CONFIDENTIALITY:  All dues Reduction Committee ("DRC") proceedings are strictly confidential.
If you wish to request a reduction in your dues, building fund, or religious school, you must fully complete this form for consideration.  A new form must be completed each fiscal year you wish to have a reduction.

Adult (partner one, P1)

Adult (partner two, P2)

Children living at home:

List reduced obligation amounts
for last fiscal year
List amount paid
last year

Statement of Ability to Pay for 23-24 Fiscal Year

Understanding that all members of Rodeph Sholom are expected to pay dues to the extent and in an amount that they are financially able to do so, I/we state that I/we can reasonably pay the following by May 31, 2024.

Payments toward obligations may be made before a reduction is received/approved.

The Dues Reduction Committee encourages applicants to use automatic credit card payment processing, a service that Rodeph Sholom provides without charge.
I/we hereby affirm that all of the information provided in this Confidential Financial Application for Reduction is true and accurate to the best of my/our knowledge.  I/we understand and agree that verification of the above statements will be provided to the Dues Reduction Committee for review upon request.
If you have questions about this form or the Dues Reduction process, please contact the Executive Director at 813-837-1911 or email


Mon, June 24 2024 18 Sivan 5784