Apply for Aid - American Families For Israel

Intake Form

The following questionnaire is for us to gain a better understanding of you. We understand that these questions and responses are highly confidential in nature. All information will remain strictly confidential. Please take the time and answer as completely and accurately as possible.

Intake Form

Please list the names and ages of all members of your immediate household/dependents:(Required)

Name

Age

What is your approximate monthly income at this time? (This includes income from work/investments/benefits)(Required)

What is the approximate monthly income you are lacking due to your loved one serving in the IDF?(Required)

What was your husband's/wife's employment? Position?(Required)

What are your current monthly expenses:

Food(Required)

Utilities(Required)

Medical(Required)

Tuition(Required)

Insurance(Required)

Rent-Morgage(Required)

Car(Required)

Child Care(Required)

Are there any new expenses being incurred due to the current situation? i.e. extra childcare?(Required)

Are you receiving any assistance from family members? If yes-how much?(Required)

Are you currently getting any assistance from outside organizations or government?(Required)

Do you have liquid assets (Bank accounts/stocks/bonds) in an amount of more than $100,000?(Required)

Please provide a reference (name/contact number) from your Husband's/wife's (the one who is abroad in the IDF) place of employment.(Required)

Please provide the name of your synagogue and name/contact number of your Rabbi. (If not applicable-skip)(Required)

Please provide the names and contact numbers of two personal references. (At least one should be a non-relative)(Required)

Is there any non-financial assistance you could use because of the current situation?(Required)

Phone, text, WhatsApp:

(516) 295-0296

Email:

info@af4i.org

mail:

25 Lawrence Ave

Lawrence, NY 11559