Stowe C19 General Relief Fund

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This is only a short-term solution to help provide basic grocery assistance until you receive federal assistance through the CARES Act. If your needs are going to be longer-term, we can help you access other organizations that can help.

1. I am a resident of Stowe. *

Yes

2. As a direct result of Covid-19, I am: *

Unemployed

Furloughed

Working materially less hours than before

No longer operating as a self-employed/small business owner

3. I am head of a household: *

Single with no dependents

Single with 1-2 dependents

Single with 3+ dependents

Married with no dependents

Married with 1-2 dependents

Married with 3+ dependents

4. My name and address: *

5. Email address: *

6. Telephone #:

I attest that the information above is truthful and correct to the best of my knowledge. *

Yes

Please be assured, all information provided will remain confidential. We will contact you within 4 days from the time you submit this survey. Thank you for your patience!

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