COVID-19 Relief Emergency Request

COVID-19 Relief Emergency Request
Please Read Before Completing Application

Welcome to FaithWorks and the Sparrow’s Nest. Although we would like to help all who are in need, with our Covid-19 funds we can only offer financial aid to clients who have experienced a Covid-19 related emergency that has caused them to be unable to pay their bills. Financial aid may include assistance with Power or Water bills and the cost of medications. We do not provide rent or mortgage assistance. All funds go directly to the service provider, no funds are given to individuals. We can only assist clients with a Covid-19 related emergency request one time.

To qualify for assistance one or more of the following Covid-19 related emergencies must apply:
- Covid - 19 Hospitalization
- Covid - 19 Positive Test Results and/or Quarantine while waiting on Test Results
- Job Loss, Furlough or reduction in hours
- Job Loss / Leave of absence or reduction in hours due to Children being at home or daycare being Closed
- Other Covid - 19 related emergency that can be explained and documented
The following DO NOT qualify for Covid-19 Emergency Financial Assistance:
- Reduction or cancellation in benefits (disability, food stamps, social security)
- Job loss/furlough with an employer that you were employed with for less than 3 months
- Emergency request that cannot be documented
If you have had such an emergency and can document this emergency, please complete the Sparrow’s Nest Application for Assistance. Staff will review completed applications and contact you with questions and verification of documentation within 3 business days.

The following documentation must be available and/or included with your application to be considered:
- Photo ID copy
- Your most recent utility bill you are requesting assistance with OR account numbers if a digital or hard copy is not available.
- If request is related to job loss/furlough
  - 1) Documentation of job loss or furlough AND;
  - 2) E vidence of 3 months longevity with employer (ie pay stubs , etc)
- If request is related to Covid - 19 testing, quarantine or hospitalization
  - 1) test results
  - 2) hospitalization records if applicable
  - 3) Evidence of quarantine requirement related to job loss/furlough
- If request is related to job loss, furlough or reduction in hours due to children being home and/or daycare being closed
  - 1) Letter stating circumstance surrounding job loss or leave of absence due to children being home
  - 2) Evidence of 3 months longevity with employer (ie pay stubs , etc)
- Prescription information (pharmacy name and phone number) – Pain medications will not be approved.
If you have not experienced a Covid-19 related emergency or cannot provide documentation of your emergency, we may not be able to help you. Other organizations that may be able to help you include:
- Coastal Community Action Authority – 912 - 261 - 9071
- Salvation Army – 912 - 265 - 9381
- St. Vincent de Paul – 912 - 262 - 6244
COVID-19 RELIEF ASSISTANCE APPLICATION
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
Email
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of adults living in your household?
Number of children (under 18) living in your household?
First Names and date of birth for children:
Type of assistance you need? *
Which circumstance is your assistance need related to? *
Other Covid-19 Related Emergency
Please explain your need for assistance and how you’ve been impacted by the Covid-19 pandemic?
Did you receive a stimulus check from the US Government?
Are you a veteran?
Is there a veteran in your household?
Has another organization or group provided financial assistance to you or your family due to the Covid-19 pandemic?
If you have received assistance from another organization or group, please list them here:
EMPLOYMENT INFORMATION
Current/ Previous Employer
Monthly Income
Supervisor Name
Employer's Phone Number
How long have you been employed there?
How many hours per week did you work?
Furlough or Job Loss Date

Month Day Year
Date
Did you receive unemployment compensation
Have you been rehired
If yes, how many hours per week?
Do we have permission to contact your utility provider or pharmacy regarding your account? *
JWSC Water/ Sewer Bill

If the following section does not apply, please skip to the next section.
Name on Account?
Account Number:
Amount Due:
Are you on a payment plan?
Is your water service currently disconnected?
Power or Gas Bill Assistance

If this section does not apply please skip to next section.
Utility Company Name:
Name on Account:
Account Number
Is this a Pre-pay Account?
What is the total amount due?
Is your power/gas currently disconnected?
Prescription Assistance

(Pain medications will not be approved) If this section does not apply please skip to the next section.
Who is this prescription for?
Pharmacy Name:
Pharmacy Phone Number:
Cost of Prescriptions:
Do you have insurance, Medicare, Medicaid or no coverage?
Other information we may need to process your request
Section 2
Documentation of your emergency is required to receive assistance.

A copy of photo ID is required.
Copy of Photo ID *

Browse Files

Cancel of
Utility Bills
- Your most recent utility bill you are requesting assistance with account numbers.
Copy of Utility Bill

Browse Files

Cancel of
Job Loss / Furlough
- Documentation of job loss or furlough AND;
- Evidence of 3 months longevity with employer (ie pay stubs, etc)
Documentation of Job Loss/ Furlough

Browse Files

Cancel of
Evidence of 3 months longevity with employer (pay stub, etc)

Browse Files

Cancel of
Covid-19 Testing, Quarantine or Hospitalization
- Test results
- Evidence of quarantine
- Hospitalization records (if applicable)
Covid-19 Test Result / Evidence of Quarantine

Browse Files

Cancel of
Hospitalization records with Covid-19 diagnosis

Browse Files

Cancel of
Job Loss / Leave of Absence Due to Children Being Home and/or Daycare Being Closed
- Letter stating circumstance surrounding job loss or leave of absence due to children being home or letter from daycare shoing closure.
- Evidence of 3 months longevity with employer (ie pay stubs, etc)
Documentation of Job Loss / Leave of Absence

Browse Files

Cancel of
Evidence of 3 months longevity with employer (pay stub, etc)

Browse Files

Cancel of
Other relevant documentation

Browse Files

Cancel of
We cannot complete your application without documentation of your emergency.
I have attached the following documents

Copy of Photo ID Copy of Utility Bill Documentation of Job Loss/ Furlough / Leave of Absence Evidence of 3 months longevity with employer (pay stub, etc) Covid-19 Test Result Hospitalization records with Covid-19 diagnosis Other relevant documentation
I certify that all of the information I have provided is true and correct:
Signature *

Clear
Date *

Month Day Year
Date
If you have questions concerning your application please contact Sabra Slade by email at sabra@faithworksministry.org or by phone (912) 261-8512 Extension 110

Staff will review completed applications and contact you via phone with any questions and verification of documentation within 3 business days.
Should be Empty:

COVID-19 Relief Emergency Request

COVID-19 RELIEF ASSISTANCE APPLICATION

EMPLOYMENT INFORMATION

JWSC Water/ Sewer Bill

Power or Gas Bill Assistance

Prescription Assistance

Section 2