Lancaster Neighbor Fund Application Form

Lancaster Neighbor Fund Application Form
Instructions

To apply for funds, please carefully follow the instructions below.
- Confirm your eligibility by visiting our website
- Answer each question and complete the entire application to the best of your ability
- Review your responses carefully before submitting
After submission, you will be contacted for next steps. Please note that we have limited funds and we prioritize those in detention.

Definitions
- Applicant: the person directly affected by detention or immigration proceedings.
- Requester: the person making the request for funds, if different from the applicant (for example a spouse or household member).
- Recipient: the person receiving the funds, if different from the applicant and requestor (for example a landlord or attorney etc.).
Basic Information
Name of applicant (the person directly affected by detention or deportation)

First NameLast Name
What is the applicant's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived in Pennsylvania?
Applicant's telephone number
Please enter a valid phone number.Format: (000) 000-0000.
How did you learn about this grant opportunity?*

Referred by a non-profitReferred by a lawyerReferred by a friend or contactOther
Provide name of organization, lawyer, friend, that referred you.*
Immigration Case
Applicant's "Alien Registration" or A number*
Does the applicant have a Notice to Appear in Immigration Court?*

YesNoUnsure
When is the applicant's next court date?

MonthDayYear
Date
Is the applicant detained? If yes, please provide the name of the detention center.

YesNoUnsure
Date of ICE Arrest

MonthDayYear
Date
Where is the applicant detained?
Does the applicant have legal representation?

YesNoUnsure
If known, please provide the name of the immigration attorney.
Household Income and Resources
Estimated income of the applicant
Estimated family income *
How many people live with applicant? *
What other family support or local services does the applicant have access to right now? (Public benefits, pro bono representation, case workers, housing assistance etc.)*
Request for Funds
Requested Amount*
Why is the applicant requesting funds? How will they use them? (Funds can be used to offset the costs of detention, such as rent, utilities, food, childcare, transportation, and bond). *
How has immigration detention or deportation proceedings impacted the applicant's finances?
Is this request time sensitive?

YesNo
If your request is urgent, please provide an explanation below. *
Name of the recipient (the person making the request for funds, if different from the applicant)

First NameLast Name
Phone Number of the recipient (the person making the request for funds, if different from the applicant)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Recipient you would like to designate to receive funds?

First NameLast Name
Recipient's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is there anything else you would like us to know about your situation? *
Consent and Terms
Do you give us permission to speak to the designee about specifics of your situation? *

YesNo
If you need additional funds for bond, do you give us permission to forward your information to the national bail fund ?*

YesNo
If you are not eligible for our funds, Do you give us permission to share your information with other groups that may be able to help? *

YesNo
Do you give us permission to share information about this grant anonymously with our donors and on social media? *

YesNo
Is all of this information correct? Please review before submitting. By submitting you are agreeing to the terms of the grant.*

YesNo
Terms of the grant, check all: *

Grants can only be issued when LNF funds are available.Your application will be reviewed in a timely fashion.We want to help as many people as possible. Please know that funds are limited and we will do our best to meet your needs.Due to limitations with funding, applicants can only receive a grant one time.
Should be Empty:

Lancaster Neighbor Fund Application Form

Basic Information

Immigration Case

Household Income and Resources

Request for Funds

Consent and Terms