NYSSCPA Temporarily Out of the Workforce Application Form 2009/2010
For details on the dues reduction policy criteria and qualifications
click here.
For
information on the NYSSCPA Benevolent Fund please click
here.
Under the
terms of its 017 reduced dues class, the Society may grant a dues reduction for the following reasons: I. Full
Unemployment
(unemployed for greater than six months and is looking for new employment) II. Full-Time Student (certified and a full time student)
III. Financial Hardship (temporary illness, disability, or full-time care for a loved one) IV. Retired (not yet 62 years of age and working less than 1,000 hours per year) V. Waiver (active military duty or an extenuating circumstance)
I. Full
Unemployment
a. Name of previous employer:
b. Last date with employer:
c. Are you currently
collecting unemployment insurance?
Yes
No
d.
Position held with last employer:
e. Length
of services with
last employer:
f. Please
specify any additional reason(s) for your reduction request.
(Optional)
II. Full-Time
Student (Please attach a copy of your current class registration).
a. Are you working
full or part-time while in school?:
Yes
No
b. When did you leave your past position?:
c. When did you return to school?:
d. How
many credits are you taking?:
e. Expected date of completion?:
f. Please specify any additional reason(s) for
your reduction request. (Optional)
III.
Financial Hardship
a. Are you currently
on SSI?
Yes
No
If yes, please
provide copy of the benefits verification letter from SSI via fax
to Member Services at 1 (866) 495-1354 or email xfox@nysscpa.org.
b. Are you on
family leave?
Yes
No
c. Are you caring for a loved one(s) with no compensation?
Yes
No
If you checked yes for b or c , when do you plan to return to
the workforce?
d. Please
specify any additional reason(s) for your reduction request.
Also, please provide date and time when income was affected.
IV. Retired
a. Are you under 62 years of age?
Yes
No
b. When did
you retire?
c. Are you
currently employed?
If yes, where are you currently employed?
d. How many
hours are you working per year?
V. Waiver
a. Are you currently on Active Duty?
Yes
No
If yes, please
provide copy of your military deployment letter from the US Government
via fax to Member Services at 1 (866) 495-1354 or email xfox@nysscpa.org.
b. Do you have extenuating circumstances?
Yes
No
If yes, please
explain in detail below and submit any supporting documentation
via fax to Member Services at 1 (866) 495-1354 or email xfox@nysscpa.org.
All applicants
must complete the section below:
a. Why do you
want to maintain your membership?
b. How can
we assist you in being more involved in the NYSSCPA?
c. Signature
required if submitting by mail. ______________________________________
Applicant’s Signature
By checking
this box, I, hereby affirm that my current status as indicated
above is authentic and I pledge to alert the NYSSCPA once I re-enter
the workforce or otherwise become ineligible for this status.
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