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2022 Empty Stocking Fund Referral Form
We have currently paused the Empty Stocking Fund and are not able to respond to referrals submitted after 12/20/2022.
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* Indicates required question
Email
*
Your email
Organization Name:
*
Your answer
Organization Contact Person:
*
Your answer
Organization Contact Person Email:
*
Your answer
Organization Mailing Address:
*
Your answer
Organization Mailing City, State, Zip Code:
*
Your answer
Is your organization a registered 501c3, Church, or Government entity?
*
Yes
No
Organization EIN #:
*
Your answer
If approved, would you like the grant check to be mailed or would you like to pick-up at the Athens Area Community Foundation offices?
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Mailed
Pick-Up
How much money are you requesting?
*
Your answer
What type of assistance is needed?
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Rent
Utilities
Medical
Other:
Required
Did you receive proof of an outstanding bill for this request?
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Yes
No
Other:
In 1-2 sentences, describe the nature of the referral (Ms. H needs $125.11 for heating assistance. She is a single mother receiving support from our organization).
*
Your answer
By submitting this request, you are agreeing to paying a bill on behalf of an individual, not giving funds directly to an individual seeking assistance.
*
Yes
No
Please provide any additional information or ask any questions! Thank you!
Your answer
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