Support Request or Refusal Form

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This form is a crucial part of the ongoing campaign to support those affected by the Boston Symphony's COVID-related shutdown. While the campaign is still running, an important step is gathering contact information for employees affected.

We ask that you provide the following information so that we may disburse funds to you, or check the "No, I decline to request support" if you do not wish to receive funds.

Disbursements will begin immediately to full-time laid off employees, followed by part-time employees and others affected.

All information below will be kept confidential and provided only to those few individuals overseeing the disbursements. All funds will be generated and mailed from the Symphony Credit Union in Boston, an independent credit union unaffiliated with those administering this fund, using the information you provide.

Please note: If you do not wish to receive support, we ask you to please fill out the form and select "No, I decline to request support." Knowing you have explicitly declined will help us direct those funds toward others in need and maintain our financial accounting appropriately.

Thank you!

Email *

First Name *

Last Name *

Were you laid off from the BSO? *

Yes

Was your organization's contract put on hold by the BSO? *

Yes

What was your position? *

Were you full-time, part-time or contracted? *

Full-time

Part-time

Contracted Employee

Do you wish to receive support from this fund? *

Yes, I would like support

No, I decline to request support

There may be additional relief funds available from other sources, organized independently from this campaign. Would you like us to share your contact information with any partner efforts to provide relief funds to laid off employees?

Yes, please share my information

No, do not share my information

Please contact me at a later date to confirm whether I would like to share my information

Clear selection

Street Address, including apartment or unit number *

City *

State *

Zip Code *

Phone *

A copy of your responses will be emailed to the address you provided.

Submit

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