COVID-19 Grant Application

COVID-19 Grant Application

We Care Community Services is distributing funds for a grant, created by TVA and Dayton City Electric through the Cares Act, to provide financial assistance to those affected by the COVID-19 pandemic. Must be a Rhea County resident.
Date

Month Day Year
Date
Head of Household Name *

First Name Last Name
Sex *

Female Male
Date of Birth *
Martial Status *
Phone Number *

Area Code Phone Number
Email
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer
Other Source of Income
Driver License #
Driver License State
Spouse Name

First Name Last Name
Spouse Date of Birth
Spouse's Employer
Spouse Driver License #

List all other's living in your home.

Full Name

Relationship

Date of Birth

Resources ($ Amount)

Work

SSI

AFDC

Child Support

Family Support

Workman's Comp

Money on Hand

Food Stamps

Other

COVID-19 Impact

Please explain how the COVID-19 pandemic has impacted you (and your family) and why you are requesting financial assistance.
Notes / Comments
Terms and Conditions: I certify that to the best of my knowledge the above information is true, and I give my permission to verify said information. Falsification of any information may be grounds for immediate denial. Upon signature I authorize a release of information on myself and listed members of my household into secured Service Point database. If needed I authorize a release to area churches.
Terms and Conditions *
Please verify. *
Signature *

Clear
Copies of Photo IDs, Social Security Numbers and COVID documentation will be required by email, text or by mail. An interview will be done via phone. Documentation showing needed assistance is caused due to COVID-19 is required (layoff stating covid, medical documentation showing covid, etc.).

All applications MUST be completed online. Once the application has been submitted and received by We Care, We Care will contact you for a phone interview within 3 business days.
Should be Empty:

COVID-19 Impact