Individual Emergency Fund

Individual Emergency Fund Application

Through our Individual Emergency Fund, all eligible victims would be provided gift cards, in the amount of $200, so they may purchase basic necessities such as food and clothing. This fund would be in time of dire need and emergency. This can be applied to any member of the community that has been affected by losing their home in a fire, flooding, foreclosures, homelessness, etc.
Name

First NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
MSU Undergraduate Chapter (if applicable)
MSU Aretias Chapter (if applicable)
Year Initiated (if applicable)
Enter 4 digit year i.e. 2018

Statement of Circumstances

Please provide a personal statement describing the circumstances of the emergency experienced and the proposed use of any funds received through this grant. Provide a list of expenses and expected amounts per expense. Please be specific.
Are you requesting funds for COVID-19 relief?

YesNo
Statement*
List of Expenses*

Please Read

I hereby certify and attest that the foregoing, including all financial information, is accurate. I understand and agree to provide further documentation as requested, which may include copies of insurance settlements, documents to verify financial assertion, or income tax statements. I further agree that, should I be selected for a grant, I will use the funds for the purpose listed or approved only. Any unauthorized use of the funds may subject me to collection action.
Signature*

Clear
Date

MonthDayYear
Date
Please check if you are comfortable with us sharing your story and a picture. This willstrengthen our mission and sustain the MUnited Nations program to help other sisters in need.

YesNo
MUnited Nations Individual Emergency Funds are for individuals in crisis and are funded by contributions to the Mu Sigma Upsilon Foundation. MUnited Nations Funds are awarded throughout the year as funds are available.
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Individual Emergency Fund Application