Jewish Free Loan of Greater Portland COVID-19 & Wildfire Relief Fund Application
Note: This information will be kept confidential, and within the confines of the Jewish Free Loan Committee and Federation staff assigned to this program.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Loan Request (MAX $1,000)
Purpose of the loan:
Are you Jewish or identify as Jewish?
Yes
No
Have you lived in Oregon or SW Washington for the past 6 months consecutively?
Yes
No
Is the need for your loan directly or indirectly attributable to COVID-19 (lost wages, childcare costs due to school closures, small business losses, medical costs, etc) OR the recent Oregon wildfires (loss of housing, evacuation expenses, etc)?
Yes
No
Most Recent or Current Employer
Position
Have you been laid off or had your hours reduced due to COVID-19?
Yes
No
Will you be able to return to work after COVID-19?
Yes
No
Not applicable
By signing this, I: 1. Certify that the information on this application is true and complete as of the below date(s). 2. Agree tat this application is the property of JFLGP and need not be returned to me. 3. Authorizes JFLGP to verify the accuracy and completeness of all information above from any source JFLGP chooses. If I am married or am a registered domestic partner and am applying for this loan in my name alone, this authorization extends to verifying information about my spouse or partner. 4. Authorize JFLGP to answer questions from, and to furnish information to, others about JFLGP’s experience with me and to discuss all aspects of this application and my loan with each person who guarantees my loan.
*
I/we understand and agree
Applicant Signature and Date
Spouse/Partner Signature and Date (if applicable)
Submit
Should be Empty: