Special Consideration Request Form

Special Consideration Request FORM
2025-2026

IMPORTANT: Please log into your account before completing this form.

We are thrilled to have you join or continue as a congregant at Temple Or Rishon. This request form is for those in great need. Temple Or Rishon wants to ensure that every person feels as though they can be part of our community while balancing our real need for financial solvency.

Here are the Full Membership Commitment rates for 2025-2026:

	Traditional Dues	Guardian Circle
Associate*	$480	$720
Single	$1920	$2640
Couple	$2880	$3960
Family	$3300	$4320
	Other Fees
Security	$250

With that, we ask that you please make every effort to meet the minimum membership commitment. If you are able to continue to pay at last year's rate, you simply have to mark this form as such and you will be done with the process, your request will be approved and we will and charge your account appropriately. If you cannot make that commitment, please fill out the rest of the application and the committee will review the request and notify you through email on the decision. Applications are kept strictly confidential, and must be resubmitted annually.

If you have questions, please do not hesitate to contact Mary Frank at mary.frank@orrishon.org

Once you fill out the form and your request is processed, your account will be updated to reflect the award of financial assistance if applicable. At that time, you will receive an e-mail notification to log in to your account and complete your renewal at the new rate.

Thank you again for your membership and continued support of Temple Or Rishon.

IMPORTANT NOTE - This year, if your household is able to pay the same amount that you paid last year, your household does NOT need to fill out this form. Choose from the two options below:

I will complete the form. I am able to continue to pay my dues at last year's rate. (If this is the case, select this and scroll to the bottom to submit this form. You DO NOT need to answer any additional questions.)

HOUSEHOLD INFORMATION

This section displays the information we have on file for your household. Please update if anything is blank or has changed over the past year.

Address Line 1

Address Line 2

City

State

Zip

Home Phone

Please use this format:916-555-1234. Also, please do not enter your mobile phone number in this field. If you do not have a home phone, leave this field blank.

MEMBER INFORMATION

This section displays the information we have on file for the adults of your household. Please update if anything is blank or has changed over the past year.

Member 1 Information

Member 2 Information

Member 1 First Name

Member 2 First Name

Member 1 Last Name

Member 2 Last Name

Member 1 Cell Phone

Please use this format: 602-971-1234.

Member 2 Cell Phone

Please use this format: 602-971-1234.

Member 1 Email Address

Member 2 Email Address

DEPENDENT INFORMATION

(Please include college age dependents.)

Dependent 1 Name

Grade in Fall of 2024

Name of School Attending

Dependent 2 Name

Grade in Fall of 2024

Name of School Attending

Dependent 3 Name

Grade in Fall of 2024

Name of School Attending

Dependent 4 Name

Grade in Fall of 2024

Name of School Attending

Any other individuals living at home?

Relationship to you

FINANCIAL ASSISTANCE REQUEST

At Temple Or Rishon, we recognize the uniqueness of each family’s financial situation. A financial award is only considered in circumstances where there is true financial need. In the space below, please describe, in detail, the reason for your request for financial consideration and any additional information not covered by this form.

Narrative

CURRENT CHARGES OF STANDARD CONGREGATIONAL COMMITMENT

Please add up the total amount of your dues, fees, and Religious School Tuition prior to any financial assistance. Please enter the number below.

TOTAL AMOUNT I/WE CAN PAY:

How long do you anticipate needing financial assistance?

SIGNATURE

By typing my name in the box below, I confirm that I regard financial consideration as a temporary situation and acknowledge that when my financial situation improves, I will return to a standard dues structure.

Please type your name in this box as your signature.

Sat, October 25 2025 3 Cheshvan 5786