Mister Cares Foundation Grant Application

Grant Overview & Eligibility

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Overview
Applicants meeting the below requirements are subject to maximum grant amounts of:

$1,500 on a rolling 12-month basis

$5,000 total lifetime
Do you acknowledge that you have read and understand the above overview and funding maximums?*

Yes
Grant Eligibility Requirements
To be eligible for a grant, you must meet the following criteria:
- Applicant must have completed at least six (6) months of consecutive employment with Mister Car Wash
- Unforeseen events causing a financial hardship, must have occurred within 120 days of submitting your application
- Your application must describe the unanticipated/unforseen event causing the financial hardship
- Your application must include clear documentation with amounts equaling or above your requested amount. It must also include your name, or the name of the responsible party and the company or entity owed money (partial screen shots will not be accepted, complete statements are preferred)
Applications and grant amount are decided on at the sole discretion of the Mister Cares Foundation Application Review Committee and are final.

Applicants will receive committee decision via email within 14 days of submission.
Do you acknowledge that you have read and understand the above requirements to be eligible for a grant and you believe you meet the requirements stated above?*

Yes
Examples of Covered Expenses

Non-exhaustive list of expense types covered by Mister Cares Foundation
- Rent or mortgage payments, if due to injury, illness or unanticipated financial circumstance, or unexpected loss of income
- Reasonable and necessary personal, family, living or funeral expenses incurred as a result of a qualifying event
- Reasonable and necessary expenses incurred for the repair or rehabilitation of a personal residence due to an unanticipated event
- Essential utility bills (water, heat, electricity, etc.)
- Travel expenses such as airfare, gas, lodging, and meals when accessing necessary medical services or attending funeral services of a family member
- Basic living expenses (food, clothing) with proper documentation
- Payment of regular monthly bills (auto payment, auto insurance, phone bill, internet bill, etc.) due to unforseen/unexpected event
Do you acknowledge that you have read and understand the above overview of eligible expenses?*

Yes
Examples of Ineligible Expenses

Non-exhaustive list of expense types not covered by Mister Cares Foundation
- Any expense, bill, payment invoiced or with a due date more than 120 days prior to the date the application is completed or dated prior to applicant eligibility period
- Loss of household income related to weather and normal business practices
- Supplemental income during employer sponsored leave of absense
- Consumer debt (credit card bills, personal loan repayment, etc)
- Accidental damages and other costs incurred due to the negligence of the applicant
- Furniture, appliances, electronics, other non-essential items
- Downpayments for vehicles/other mode of transportation
- Non-essential utilities such as cable television and monthly subscriptions
- Legal fees or items related to criminal activity, child support, divorce, etc.
- Expenses that are or would be covered under medical/homeowners/other insurance and associated deductibles
- Standard living expenses that do not cause financial stress
- Tuition and/or education related fees (student loans, tuition payments, books, etc)
- When other aid or assets are readily available
Do you acknowledge that you have read and understand the above overview of ineligible expenses that are not covered by the Mister Cares Foundation?*

Yes

Applicant Details
Name*

First NameLast Name
Mobile Phone Number*
Please enter a valid phone number.
Personal Email*
example@example.com
Position/Title*
Mister Car Wash Employee ID Number*
Must be seven digits ex. 000001
Mister Car Wash Location Number*
Must be four digits. If your location is only three digits, please enter leading zero. Example: 0692 or 1321. HQ Employees, please enter your department Cost Center. Example: 9008, 9005.
Hire Date with Mister Car Wash*

MonthDayYear
Please be as precise as possible. If rehired, please enter date of rehire.

Hardship Details
Date of event causing the need for assistance (must be within 120 days of application)*

MonthDayYear
Date
Please provide the total dollar amount you are requesting from Mister Cares Foundation*
Please describe the hardship and the need for assistance. Be as complete as possible - i.e. what is the hardship, what lead to the hardship, how is it unforseen etc. *
How does the incident above prevent you from meeting your financial needs?*
Please list the payments/bills that are impacted by the above incident/hardship that you would like Mister Cares Foundation to assist with.*
What other steps or resources have you explored to help with your financial need before applying for assistance?*
Is this incident covered in full/partially by insurance? I.e. Health Insurance, Auto Insurance, Renters Insurance, etc.*
If yes, has a claim been submitted?*

Household Information
How many ADULTS live in your household, including yourself?*
How many CHILDREN/DEPENDENTS live in your household?*
Monthly total household take home pay:*

Document Submission
Incomplete or inadequate documentation will cause a submission to be declined.

Documentation must include amounts equal to or above your requested amount.

Documentation must also include your name, or the name of the responsible party, and the company or entity owned money.

Partial screen shots will not be accepted.

Below is a non-exhaustive list of common documents you may submit:
- Receipts of incurred expenses
- Overdue billing statements or eviction notices
- Funeral costs/estimates
- Summary of medical expenses owed after insurance or prior payments have been applied
  - It is recommended you do not submit documentation containing diagnosis, treatment plans, or other HIPPA related information
- Lease agreement for primary residence
Upload documentation*

Cancelof

Acknowledgment
No individual is entitled to receive a grant, either by their employment, their history of contributions to the Foundation, because of any precedent inferred from a previous grant from the Foundation, or any other circumstance.

Reasonable efforts will be made to keep this application confidential.

Do not submit sensitive information such as social security numbers or bank account numbers on this form.

Applicants are expected to provide truthful and accurate information.

In its due diligence, if the Foundation discovers any information to be untrue, it shall have the right to unilaterally waive its confidentiality and report its findings to Human Resources and/or management; further, all non-dispersed funds will be forfeited.

By submitting this form, I verify that the information provided with this application is true and complete.

I authorize the Foundation to obtain and verify all information necessary to process and confirm this application, including but not limited to a character reference from my immediate manager and their immediate manager, and I will provide additional supporting documentation when requested.

I further authorize the Foundation and its service providers to use or disclose any attached protected information to evaluate eligibility of grant assistance.

Applicant understands if application is approved, they will have 14 days from the date the affidavit is sent to accept the grant via affidavit. Failure to accept within this timeframe will result in forfeiture of the grant, and you will need to reapply for future consideration.
Signature*

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Date Signed

MonthDayYear
Date
Assistance with Application

If you have any questions regarding the application process, please contact the Mister Cares Foundation at admin@mistercaresfoundation.org. All communications are kept confidential.
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Grant Overview & Eligibility

Overview

Grant Eligibility Requirements

Examples of Covered Expenses

Examples of Ineligible Expenses

Applicant Details

Hardship Details

Household Information

Document Submission

Acknowledgment

Assistance with Application