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  • The DMF continues its mission to help individuals and families within our community.

    The following questionnaire is for us to gain a better understanding of you.

    It will allow the DMF to better cater the programs, sales, discounts and services which we provide. DMF is actively seeking to offer more programs, your responses will help us identify where there are needs.

    We understand that these questions and responses are highly confidential in nature. All information will remain strictly confidential.

    We understand many face financial stresses, we also understand there are many variables to everyone’s unique situation.

    Please take the time and answer as completely and accurately as possible. Your honest feedback and responses to this questionnaire is much appreciated.

    With appreciation,

    The DMF

  • If not applicable please write N/A
    NameBirth MonthBirth YearGenderSchool 
  • Please describe Approximately costs per year for their care?
  • If not applicable please write N/A
    Husband and Wife's First and Last NameCity, State where they reside 
  • This includes Elderly Parents, etc.
  • First and Last NameRelationship to you 
    If not applicable please write N/A
  • Approximately how much annually do you provide?
  • Kollel NameAttending Kollel Since (Year) 
  • School AttendingDegree PursuingAnticipated Graduation Date 
  • School NameDegree PursuingExpected Graduation Date 
  • School NameDegree PursuingExpected Graduation Date 
  • Please include all parsonage and untaxable income. As with all questions on this questionnaire, all responses are kept strictly confidential.
  • Besides for monthly monetary support, does your former spouse share other financial responsibilities. for example Tuition, Camp, Simchos, Etc.
  • This includes family, communal, friends etc. support. Consistent support is defined as repetitive financial assistance from sources outside of your employment.
  • For example, Tuition, Car payments, Medical, therapy, housekeeping etc.
    Name of ExpenseAnnual Cost 
  • For example, medical, simcha
    Name of ExpenseCostYear of occurence 
  • DebtorAmount owed 
  • Choose all that apply
  • For example sales or discounts on clothing and food. We welcome any ideas.
  • Davis Memorial Fund
    25 Lawrence Avenue Lawrence, NY 11559
    P. 516-295-0296
    E. [email protected]