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Stimulus Check Redistribution Form
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
.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone Number
Your answer
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
Other:
I would prefer my check go to...
*
an individual
an organization
Please redistribute my check where it will have the greatest impact
Other:
Required
Have you already pledged to redistribute your check through another organization?
Yes
No
Other:
Clear selection
Anything else you want us to know?
Your answer
Thank you for your commitment to resource redistribution during this crisis!
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