New Member Application - Form - University Synagogue

Submission of this form requires an Online Payment to be made via credit card or e-check.

For our 40 and Under Membership form please click here.

How did you hear about University Synagogue?

Referred by whom?

Please describe:

The primary reasons I/we joined University Synagogue are:

Call me/us.

I/we still have questions and want more general information about University Synagogue.I/we am/are eager to learn more so I/we can become actively involved, particularly with:

* Is there a second adult applying for membership?

Adult 1 - Title

Adult 1 - First Name

Adult 1 - Last Name

Adult 1 - Nickname

Adult 1 - Gender

Adult 1 - Other Gender:

Adult 1 - Pronouns (she/he/they)

Adult 1 - Date of Birth

Adult 1 - Cell Phone

Adult 1 - Email Address

Adult 1 - Marital Status

Adult 1 - Anniversary Date

Adult 1 - Occupation

If retired, what was your profession?

Adult 1 - Employer/Business Name

Adult 1 - Work Phone

Adult 1 - Religious Background

Adult 1 - Other:

Adult 1 - Hebrew Name

I don't have a Hebrew name but would like one.

University Synagogue has a wealth of committees, programs, and projects. We invite you to become active in them. Involvement in these groups is a way to meet members with similar interests, become part of our Jewish community, and participate in carrying out the ideals of the synagogue.

Please indicate the committees that interest you. We will place your name(s) on the contact list and have someone call or email you in regard to future meetings and projects.

Adult 1 - Interest In:

Women’s GroupsMen’s Groups

Adult 1 - Other interests, hobbies, special skills, foreign languages, talents (e.g. music, computers, sports, etc.):

Adult 1 - Previous synagogue or organizational experiences, including committees (Jewish/non-Jewish):

Adult 1 - I/we hope University Synagogue will serve my/our needs in the following ways(s):

The following questions are designed solely to offer you High Holiday honors and to guide our programming and outreach:

Adult 1 - Do you read Hebrew?

Adult 1 - Can you chant Torah?

Adult 1 - What is the nature and background of your Jewish education?

Adult 1 - Besides English, which foreign language(s) can you speak or read:

HAVURAH, Hebrew for friendship group, is a special program for those who choose to become members of University Synagogue. Havurot (plural) enable congregants to become acquainted in smaller, more intimate friendship groups based on compatible needs and interests. Most Havurot begin with people who did not previously know each other, but over time, individuals and families have built friendships and bonds that will endure over their lifetimes. Each Havurah formulates its own personality, goals, and activities and typically averages between ten and twenty people. If you would like to join a Havurah, please complete the questions below to assist us in finding the best match and compatibility in a group for you.

Adult 1 - Which do you prefer? (check one)

Primarily adult eventsEvents where children usually participateCombination of events (1⁄2 children, 1⁄2 adults)

Adult 1 - Is there anything else about you that would help us place you in a Havurah and that will make it enjoyable and compatible for you?

Adult 2 - Title

Adult 2 - First Name

Adult 2 - Last Name

Adult 2 - Nickname

Adult 2 - Gender

Adult 2 - Other Gender:

Adult 2 - Pronouns (she/he/they)

Adult 2 - Cell Phone

Adult 2 - Email Address

Adult 2 - Date of Birth

Adult 2 - Occupation

If retired, what was your profession?

Adult 2 - Employer/Business Name

Adult 2 - Work Phone

Adult 2 - Religious Background

Adult 2 - Other:

Adult 2 - Hebrew Name

I don't have a Hebrew name but would like one.

Please indicate the committees that interest you. We will place your name(s) on the contact list and have someone call or email you in regard to future meetings and projects.

Adult 2 - Interest In:

Women’s GroupsMen’s Groups

Adult 2 - Other interests, hobbies, special skills, foreign languages, talents (e.g. music, computers, sports, etc.):

Adult 2 - Previous synagogue or organizational experiences, including committees (Jewish/non-Jewish):

Adult 2 - I/we hope University Synagogue will serve my/our needs in the following ways(s):

The following questions are designed solely to offer you High Holiday honors and to guide our programming and outreach:

Adult 2 - Do you read Hebrew?

Adult 2 - Can you chant Torah?

Adult 2 - What is the nature and background of your Jewish education?

Adult 2 - Besides English, which foreign language(s) can you speak or read:

Adult 2 - Which do you prefer? (check one)

Primarily adult eventsEvents where children usually participateCombination of events (1⁄2 children, 1⁄2 adults)

Adult 2 - Is there anything else about you that would help us place you in a Havurah and that will make it enjoyable and compatible for you?

Address

City

State

Zip Code

Home Phone

if applicable

Home Email

if applicable

Mailing Address (if different than residence)

Name of Emergency Contact

Relationship to you

Phone Number

Email Address

* How many children are part of this membership unit?

Please check this box if you currently have or plan to have a child enrolled in the University Synagogue Pre-School

Child 1 - First Name

Child 1 - Last Name

Child 1 - Nickname

Child 1 - Hebrew Name

Child 1 - Gender

Child 1 - Pronouns

Child 1 - Date of Birth

Child 1 - Is child living at main residence?

Please indicate address

Child 1 - Grade

Child 1 - School

Child 1 - Are you interested in enrolling your child in Religious School (Pre-K through 12th Grade)?

Child 2 - First Name

Child 2 - Last Name

Child 2 - Nickname

Child 2 - Hebrew Name

Child 2 - Gender

Child 2 - Pronouns

Child 2 - Date of Birth

Child 2 - Is child living at main residence?

Please indicate address

Child 2 - Grade

Child 2 - School

Child 2 - Are you interested in enrolling your child in Religious School (Pre-K through 12th Grade)?

Child 3 - First Name

Child 3 - Last Name

Child 3 - Nickname

Child 3 - Hebrew Name

Child 3 - Gender

Child 3 - Pronouns

Child 3 - Date of Birth

Child 3 - Is child living at main residence?

Please indicate address

Child 3 - Grade

Child 3 - School

Child 3 - Are you interested in enrolling your child in Religious School (Pre-K through 12th Grade)?

* I/we wish to have the following Yahrzeiten (anniversaries of death) acknowledged.

Yahrzeit Information (Name)

Relationship

Relationship to whom?

Date of Death (English date & year)

Observe on Hebrew or English Date

Yahrzeit Information (Name)

Relationship

Relationship to whom?

Date of Death (English date & year)

Observe on Hebrew or English Date

Yahrzeit Information (Name)

Relationship

Relationship to whom?

Date of Death (English date & year)

Observe on Hebrew or English Date

Yahrzeit Information (Name)

Relationship

Relationship to whom?

Date of Death (English date & year)

Observe on Hebrew or English Date

Please choose your Commitment type:

Regular Membership
Couple (with or without children) - $3,310 by June 30 / $3,435 beginning July 1
Single (with or without children) - $1,840 by June 30 / $1,915 beginning July 1

Select One:

Fair Share Program

University Synagogue offers the Fair Share Program to those members who are unable to pay full commitment rates. The Fair Share Program is based on Adjusted Gross Income (AGI). It should be calculated from your 2023 income tax return. Below is the Fair Share breakdown. If you are able to increase your commitment beyond your category, we would greatly appreciate your support. If you are interested in the Fair Share Program, please contact Myka Thompson at mthompson@universitysynagogue.org.

Note: The adjustment table is based on a survey of synagogue membership structures and on known rates of charitable giving throughout the United States based on AGI. The average charitable donation for incomes between $50,000 and $100,000 is $2,877 per year.

Annual Commitment AGI
$2,750 $120,000 - $139,000
$2,450 $100,000 - $119,000
$2,150 $90,000 - $99,999
$1,900 $80,000 - $89,999
$1,700 $70,000 - $79,999
$1,450 $60,000 - $69,999
$1,250 $50,000 - $59,999
$980 $40,000 - $49,999
$700 $30,000 - $39,999
$460 $29,000 and below

Living Judaism/Pre-School Membership

1st Year Religious School - Couple - $790 / Single - $660

2nd Year Religious School - Couple - $1,210 / Single - $1,080

3rd Year Religious School - Couple - $2,060 / Single - $1,930

1st/2nd Year of our Pre-School - Couple - $1,110 / Single - $980

Select One:

Supporting members contribute over and above basic membership commitment rates. Their participation enables University Synagogue to fund vital programs, fulfill our mission of inclusivity and ensure the sustainability of our congregation. If you wish to provide some additional support to University Synagogue, please follow the steps below. We thank you for your generosity and continued support.

SUSTAINER - contribute an additional $360.
PATRON - contribute an additional $720.
GENERATIONS - contribute an additional $1,000.
CHAI BENEFACTOR - contribute an additional $1,800.
CHAI TZEDAKAH - contribute an additional $3,600.
ELIJAH’S CIRCLE - contribute an additional $7,200.
TENT OF ABRAHAM AND SARAH - contribute an additional $10,000.
COVENANT - contribute an additional $18,000.

Click here to read more about each of our Support Opportunities and the benefits provided to you within each category.

Click here for more information about our Generations level of support.

Please choose an Additional Support Level:

Total