Stimulus Check Redistribution Form

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Please let us know how you would like to redistribute your stimulus check to those who need funds in this difficult time. Let us know if you have any questions, you can email us at surjbemergencyresponse@gmail.com.

电子邮件地址 *

Name *

Phone Number

Yes, I would like to pledge my stimulus check to support my community during the COVID-19 crisis! *

I am interested in contributing all of my check (or an equivalent $1200 contribution)

I am interested in contributing part of my check

其他:

I would prefer my check go to... *

an individual

an organization

Please redistribute my check where it will have the greatest impact

其他:

必填

Have you already pledged to redistribute your check through another organization?

Yes

其他:

清除所选内容

Anything else you want us to know?

Thank you for your commitment to resource redistribution during this crisis!

提交

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