Red Rock Recovery Fund — Employee Assistance Grant Application ($1,000)

Red Rock Recovery Fund — Employee Assistance Grant Application ($1,000)

The Red Rock Recovery Fund, a fund of the Sedona Chamber of Commerce Foundation (501(c)(3)), provides flat $1,000 need-based grants to individuals employed by small businesses in the Pocket Fire impact area* at the time of the disaster. This is a need-based charitable grant: it is NOT taxable income to you, the Foundation will not issue you a Form 1099, and you do not need to provide a Social Security number. Grants are paid by check. Funds are limited; qualifying does not guarantee an award. Every applicant will receive our community resource sheet whether or not a grant is awarded. Grant applications close Friday, August 28th. *Click here to see the designated impact area: https://sedonachamber.growthzoneapp.com/ap/CloudFile/Download/LbB4yAjL
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address at Time of Disaster

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you, or an immediate family member, a Foundation or Chamber board member, Grant Committee member, Fund donor, or Fund staff?
Please explain
Employment at Time of Disaster
Employer Business Name
Employer Street Address
Employer ZIP Code
Job Title / Role
Were you employed by this business at the time of the disaster?
Employment Verification (e.g. a recent pay stub, employer letter, or other official documentation).

Cancelof
Disaster-Related Need
Were you displaced from your home by evacuation or damage?
Dates displaced

MonthDayYear
Date
Lost work or wages due to the disaster
Estimated lost wages amount (USD)
Supporting documentation (e.g. pay stub or letter from employer verifying you were furloughed)

Cancelof
Other assistance received
Amounts received from other assistance
Payment by Check
Check Payee Name
Current Mailing Address for Check

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Attestations and Signature
Attestation 1
Attestation 2
Attestation 3
Attestation 4
Attestation 5
E-signature
Date

MonthDayYear
Date
Should be Empty: