Apply for Funds - THE SARAH ADELMAN MEMORIAL FUND

REQUEST FOR FUNDS FROM THE SARAH ADELMAN MEMORIAL FUND

The primary focus of The Sarah Adelman Memorial Fund is to provide financial support to needy families in the St. Louis Jewish Orthodox community whose children require assistance in obtaining counseling services. We would appreciate it if the identity of the person seeking assistance is kept anonymous. If your request matches our mission, PLEASE PROVIDE YOUR EMAIL ADDRESS (without identifying the person for whom funding is requested) and complete the following form:

Please provide the email address of the person or representative who is submitting this request. *

Is the applicant or his/her family members of the St. Louis Jewish Orthodox community? *

What synagogue does the child's family attend? (Type N/A if none) *

Examples are, Young Israel, N/A

What school does the child attend? (Type N/A if none) *

Examples are: H F Epstein Hebrew Academy, N/A

If you are seeking funds for treatment from a therapist, please identify the name of the therapist. *

If you are seeking funds for treatment from a therapist, please identify the phone number of the therapist. *

If you are seeking funds for treatment from a therapist, please identify the physical address of the therapist. *

If you are seeking funds for treatment from a therapist, please identify the email address of the therapist. *

What are the per visit charges for the therapist? *

What are the number of therapy sessions requested to be funded? *

Total Expenses: *

Less: Amount family will contribute *

Our fund supplements what the family can afford to pay.

Amount of expenses requested from the Fund *

Phone