APPLICATION FOR ASSISTANCE | BENEVOLENCE FUND
Assistance is generally provided once during a twelve-month period for members. Please email this application and related documentation to Benevolence@thekappafoundation.org
Applicant Information
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MEMBERSHIP INFORMATION
Are you a Member of Kappa Alpha Psi Fraternity, Incorporated?
*
Yes
No
If yes, what is your current Affiliation?
If no, are you related to a member of Kappa Alpha Psi Fraternity, Incorporated?
Yes
No
If yes, what is your relation?
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FINANCIAL INFORMATION
In your opinion which description best describes your financial situation?
Short Term Emergency
Short Term Problem
Long Term Problem
Briefly, what events led to you needing assistance?
*
Are you currently employed?
Yes
No
Full-Time
Part-Time
If married, is your spouse employed?
Yes
No
Full-Time
Part-Time
Members of Your Household
*
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Housing:
Own/Purchasing
Renting
Do you have access to a car?
Yes
No
If Yes, is it:
Owned (Paid for)
Owned (making payments)
Leased
Borrowed
A family member
If making payments, how much until the car is paid off?
Any Additional Notes:
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Financial Overview
Monthly Income Sources
*
Total amount: Monthly Income ($):
Monthly Expenses Incurred
*
Total amount: Monthly Expenses ($):
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ANY SPECIAL ASSISTANCE REQUESTED
Please be specific for assistance requested and provide a copy of the bill showing the amount due.
Company Assistance Information
*
Total assistance requested ($):
File Upload- Please provide a copy of the bill showing the amount due.
*
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APPLICANT’S ACKNOWLEDGEMENT
Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
OFFICIAL USE ONLY
Approval
Approval via email
Approved at meeting
Need more infromation
Denied
Reason Denied
Request Additional Information
Amount Approved
Should be Empty: