JACK STACK HOPE FUND APPLICATION

JACK STACK HOPE FUND
APPLICATION FORM
Started in 2005, the Jack Stack HOPE Fund is to provide financial assistance for employees of Jack Stack BBQ, Catering, and Retail in the face of emergencies when all other resources have failed. The HOPE Fund is Funded by our team for our team. This fund is designed to be a hand up not a handout in times of need. Requests up to $2,000.00 will be reviewed by The HOPE Committee.

Rules of the HOPE Fund
- You must be an active employee with six months or more of continuous service.
- $2,000 Maximum Award, per household, within a 12-month period.
- All Awards are gifts, and no repayment is necessary. Payments are made directly to vendors and not directly to our employees.
- Applications are kept strictly confidential and reviewed by the HR committee only.
The application must be completed in full. Failure to do so will delay the committee's decision and therefore, the HOPE Funds being awarded and paid.

Required Documentation
- 4 Paychecks or most recent W2 for all adults in the household either Spouse or Significant other.
- Copies of all bills to be paid by the HOPE fund if awarded
- Applications will not be reviewed with the committee until all supporting documentation is received.
All information about anyone requesting funds is confidential. All decisions of the HOPE Fund Review Committee are final; however, the ultimate decision and distribution of funds will rest with Helping Hands Ministries, Inc.

The HOPE Fund is made possible through gifts from your fellow employees, Jack Stack and Vendors.

Please Complete the following information:
Date*

MonthDayYear
Date
Hire Date*

MonthDayYear
Date
Name*
Address*

Address

Street Address Line 2

CityState

Zip
Phone Number*
Email*
example@example.com
Last 4 of Social Security Number*
Location*
Job Title*
Have you or a immediate family member received HOPE Funds in the past?*

YesNo
If Yes, Who and what year?
Please provide as much detail as possible. The HOPE Committee will be reviewing your situation and the only information they have to determine if they will grant or deny the HOPE Fund request is what is documented below. Please provide the full situation and the reason for requesting financial assistance. Keep in mind, the Committee only has the information provided to make their determination.*
Number in household*
Names of those in household with Age, Occupation or Student*
Monthly Income

If you do not have a significant other or that income, please place a 0
Wages of Applicant*
Wages of Spouse or Significant Other*
Child Support/Alimony
Child Support/Alimony of Spouse or Significant other
SSI/Disability
SSI/Disability of Spouse or Significant other
Other Income
Other Income of Spouse or Significant other
Total monthly household income from all sources*
Savings Account*
Monthly Bills

Please note, if you do not have a monthly bill for any of the options, place a 0.
Rent/Mortgage*
Cable/Satellite*
PowerElectricity*
Internet Service*
Car Payments*
Gas*
Total Child Care*
Water/Sewer*
Phone Bill*
Auto Insurance*
Credit Card Payments*
Loan Payments*
Garnishments
Other
How much financial assistance would you like to receive $100 to $2000 Max*
Please Provide the following - Last 4 paystubs and Significant Other or Spouse. Copies of the bills needed to be paid (Must have account information on them). *

Cancelof
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

JACK STACK HOPE FUND

APPLICATION FORM

Monthly Income

Monthly Bills