From The People To The People
Funding & Assistance Application
Thank you for reaching out. This application helps us understand your situation so we can fairly review your request. All information provided will be kept confidential and used only for the purpose of assessing your request.
Personal Information
Full Legal Name:
Date of Birth:
-
Month
-
Day
Year
Date
Current Address:
City & Province:
Postal Code:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
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Household Information
Number of Adults in Household:
Number of Children/Dependents:
Please list names and ages of dependents (if applicable):
Employment & Income Information
Employment Status (select one):
Employed
Self-Employed
Unemployed
On Benefits
Other
Employer Name (if applicable):
Monthly Income (approximate):
Other Sources of Income (if applicable):
Financial Situation
Please describe your current situation and why you are requesting assistance:
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Type of Assistance Requested
Rent / Housing Support
Utility Bills
Food / Essentials
Emergency Assistance
Other:
Other
Dietary Requirements & Allergies (If Applicable)
To better support your needs, please let us know if there are any dietary restrictions or
allergies, we should be aware of:
Dietary Restrictions/Allergies
No dietary restrictions or allergies
Yes (please specify):
Are these restrictions due to:
Medical reasons
Allergies
Religious or cultural reasons
Other:
Other
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Amount Requested
Amount Requested:
What will this funding be used for specifically?
Supporting Documentation (Required if available)
Please attach or provide the following:
Supporting Documents
Proof of overdue bills or notices
Bank statements (up to 3 months)
Proof of income
Eviction or disconnection notices (if applicable)
Any additional supporting documents
Consent & Verification
By submitting this application, I confirm that:
Consent & Verification Statements
The information provided is true and accurate to the best of my knowledge
I understand that additional information may be requested
I consent to the verification of the information provided
I understand that submission does not guarantee approval
Signature
Applicant Name:
Signature:
Date:
-
Month
-
Day
Year
Date
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