Radical Relief Fund Survey Website

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**Due to the high volume of applications we have received, we have decided to temporarily postpone our site. You are welcome to submit a form to be considered in the future. Thank you so much.

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Welcome to the Radical Relief Form! If you are suffering financially as a result of the current crisis, fill out the form below and send us a quick video describing your needs (under 2 minutes, nothing fancy you can just use your phone). When times get better, pay it forward instead of paying it back.

*Funds provided by the Radical Relief Fund, funded by the FitFoundation (501c3).

Email *

Name: *

I am applying for the following:

RRF for Single Parents

RRF for Artists, Musicians, or Entertainers

RRF for Educators or Caregivers

RRF for Financially Deficient

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Pleas tell us what you do, how much money you're asking for, and what you need the money for. *

Have you received any money from other stimulus packages? If yes, tell us which one. *

Please send a video of yourself telling us 1) your name 2) what you do and 3) how much money you need and what you need it for. Send to konradical@radicalrelief.fund or to @radicalrelieffund on Instagram!

Done

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We will not use your video submission without your permission, unless noted here: *

I am ok with you using my video submission for outreach to raise money

I am ok with my video or other images that I submit being posted publicly

I would prefer if you didn't use my video for any other purpose than grant evaluation at this time

Required

By submitting this application for financial aid, I hereby release and agree to indemnify, defend and hold harmless Radical Relief Foundation including its parents, affiliates, officers, directors, agents, attorneys, employees and other representatives, from any and all liabilities, claims, damages, costs and/or responsibilities in association with my application for and/or receipt of financial aid. Additionally, I understand that the submission of an application is not a guarantee of receiving funds. I also accept the Google terms of service listed below, which apply equally to the Radical Relief Fund: *

Agree

Required

Do you have any other comments?

Submit

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