MLK Arts Academy Family Financial Assistance Application Form

Purpose:

Forest Forward recognizes that life outside of the school day can heavily impact a child’s educational achievement and overall school experience. Forest Forward works to identify, convene, and align student and family support service providers to target student needs and deliver a more comprehensive and cohesive network of support resources to improve academic and whole child outcomes. Forest Forward is committed to parent engagement initiatives and partners to provide emergency assistance and support for MLK Art Academy families in need.

Funds will be approved on a first come, first served basis for applications that meet eligibility criteria. To help reach as many families as possible, priority will be given to those who have not yet received support.

Priority will also be given for households at risk of housing termination.

Criteria for Eligibility:

1. Must be a parent and/or guardian of a current MLK Art Academy student.
2. Must have incurred financial hardship and in need of the basic necessities.

Application Procedure:

The application must be completed in its entirety.

The following documentation is required for consideration:

1. Driver's License or State Identification

2. Proof of residence

3. Financial Assistance documentation required:

Rental Assistance- please submit a residential lease and current balance ledger

Utility Assistance- please submit the utility bill dated within the last 30 days

Other Financial Assistance- please submit the bill dated within the last 30 days

Financial assistance for food is currently not available, however, food assistance referrals can be provided.

No decision will be reached on an application until all requested information has been received.

Payments will be paid directly to the landlord/utility provider on the behalf of the individual named in the application that meets the criteria.

Application Approval:

MLK Arts Academy Family Financial Assistance applications received by Forest Forward will be reviewed and applicant will be notified within 7 days of application.

Date*

Date

Name of Applicant*

First NameLast Name

Date of Birth*

Date

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

Enter the contact persons email address

Phone Number*

Area CodePhone Number

Race*

Spoken Language*

EnglishSpanishOther

Number of members in your household:*

Please list all members in your household (Name and Date of Birth):*

ex: John Doe, 1/1/1900

Please list all children currently attending MLK Arts Academy (Name and Grade):*

ex: John Doe, 5th grade

Employment Status:*

Full-timePart-timeUnemployedOther

Income Source:*

EmploymentUnemployment InsuranceSSI/SSDIOther

What is the total annual household income: *

ex: $30,000

Please provide a brief statement describing your need for financial assistance and how funding will aide you and your family:*

0/75

Assistance Needed:

Amount of financial assistance requested:*

ex: $500.00

Please provide your Driver's License or State Identification:

Upload File

Please provide proof of residence if different than ID:

Upload File

Please provide lease and/or balance ledger (if applying for rental assistance):

Upload File

Please provide utility bill (if applying for rental assistance):

Upload File

Please provide other financial assistance bill (if applying for other assistance):

Upload File

I authorize and grant Forest Forward permission to verify my child's enrollment at the Dr. Martin Luther King, Jr. Arts Academy with the Academy's administrative staff.

Applicant Assurance:

By typing or signing my name below, I certify the statements herein are true, complete and accurate to the best of my knowledge, and that I have a valid need for the funds. I am aware that any false, fictitious, or fraudulent statements or claims are grounds for an immediate refusal of my application. I agree to accept responsibility for providing any personal reports if financial assistance is awarded as a result of this application. I understand that the granting of emergency assistance is neither a right nor an entitlement and that Forest Forward staff shall have the sole discretion to determine whether I qualify for assistance.

Date*

Date

Please verify that you are human*

Signature*

MLK Arts Academy Family Financial Assistance Application

Applicant Information

Household/Financial Information

Authorization, Release, and Consent