JCI Shakopee - Hardship Donation Request Application
To better meet the needs of those experiencing hardship, and to protect the interests and needs of the chapter, we would ask for you to fill out this application.  This information may be shared with the Board of Directors and the general membership (as appropriate) to help us determine how we can best support your request.

If you have any questions about the process, or wish to discuss your request prior to submitting this form, please contact (FILL IN HERE).
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Name of Requesting Party *
Phone Number *
Email Address *
Member status: *
Please provide a brief (up to 250 words) description of the situation/hardship you are facing: *
To what extent has this hard affect you in the following areas? *
No Effect
Minimal Effect
Significant Effect
Major Effect
Severe Effect
Housing/Home
Health/Well-Being
Financial Security
Job/Career
What steps have you taken to address the situation? *
What assistance are you requesting from the chapter? *
If you are requesting financial assistance, how much money are you requesting?  Who would receive these funds? *
Is there any other information you wish to provide?
Submit
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