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SAPC COVID-19 Benevolence Fund Assistance Request Form
Please complete form below to request funds from the SAPC COVID-19 Benevolence Fund
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Address
*
Your answer
Preferred Phone Number
*
Your answer
Number of People in Household
*
Your answer
Employment Status
*
Full-Time
Part-Time
Self-Contracted
Furloughed
Under-employed
Unemployed
Other
Required
Amount Requesting
*
Disclaimer: The Committee will be disbursing funds in $350-$500 increments. We encourage those with extraordinary need to detail that need below and to reapply for additional funds.
Your answer
Reason for Requesting Funds
*
Your answer
Are you a member of SAPC?
*
Yes
No
Are you a community member?
*
Yes
No
Are you currently receiving financial assistance?
*
Yes
No
If yes, from whom?
Your answer
How did you hear about the Benevolence Fund?
*
Your answer
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