Port Clyde Strong Fund Application

This fund is intended to provide short-term assistance to ensure St. George residents and business owners impacted by the September 2023 fires in Port Clyde have the necessities they require, such as food, clothing, housing, transportation, and medical assistance (including psychological counseling).  Assistance may also be provided in the form of cash grants for necessary services, which are paid directly to the service providers.  Funds are not distributed to individuals or families.  The type of aid that is appropriate depends on the applicant's needs and available resources.

We can only provide disaster assistance to a business if the assistance is a reasonable means of accomplishing a charitable purpose, and any benefit to a private interest is incidental to accomplishing a charitable purpose. 
Qualified assistance payments do not include payments for expenses otherwise paid for by insurance or other reimbursements or income replacement payments, such as payments of lost wages, lost business income, or unemployment compensation.


Email *
Applicant Full Name *
Applicant's Street Address *
Applicant's Mailing Address *
Applicant's Phone (best for contact) *
Tell us about the members of your household (number of adults, seniors, children, etc) *
Current Employer *
Request & Narrative
Please provide a narrative of your current need and how it relates to the Port Clyde fires of September 2023.
 *
Have you requested assistance from other organizations, insurance agencies, employers, or unemployment offices? *
If Yes, which agencies have you contacted for assistance
Total amount of assistance being requested *
All payments are made directly to the provider of services (landlord, electric company, heat, etc).  Please provide the providers contact information including name, phone, email or address.  We will be in contact for documentation of your request. *
By completing this form and selecting 'I Agree' below, I acknowledge that I have read and understood the terms and conditions below and agree to abide by them.

The applicant hereby acknowledges and agrees to the following terms and conditions regarding the application for financial assistance from the Port Clyde Strong fund held at the St. George Community Development Corporation:

I understand that I am applying for financial assistance from St. George Community Development Corporation to help alleviate financial burdens related to Port Clyde fires of September 2023.

I understand that providing false or misleading information on this application may result in the denial of financial assistance or legal action.

I authorize St. George Community Development Corporation or a committee thereof to verify the information provided on this application through appropriate means, including but not limited to contacting third parties, such as employers, financial institutions, and government agencies, to confirm my financial status and eligibility for assistance.

I understand that the information I provide in this application may be subject to review by St. George Community Development Corporation and its authorized committee representatives.

I waive any right to confidentiality or privacy with respect to the information contained in this application, to the extent permitted by applicable law. I understand that St. George Community Development Corporation will use this information solely for the purpose of evaluating my eligibility for financial assistance.

I release St. George Community Development Corporation, its officers, employees, agents, and representatives from any liability or claim arising out of the collection, use, or disclosure of the information provided in this application, to the extent permitted by applicable law.

I acknowledge that the decision to grant or deny financial assistance is at the sole discretion of St. George Community Development Corporation, and I agree to abide by their decision.

I understand that the provision of financial assistance is subject to the availability of funds in the Port Clyde Strong Fund and compliance with St. George Community Development's policies and procedures.

*
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of St. George Community Development Corporation. Report Abuse
Google Forms