COVID-19 Grants Request Form
Funded and in partnership with Sierra Health Foundation and Sacramento County, Hmong Youth and Parents United (HYPU) COVID-19 Assistance Grants are intended to address the impacts of COVID-19 and to quickly provide financial support and community resources to the Hmong and other underserved communities who are facing financial hardships in Sacramento County.

Types of COVID-19 Assistance Grants available:
1. COVID-19 Emergency Assistance Relief Fund for Families

Upon completion and receipt of this request form, a HYPU Resource Coordinator will be in contact with you within 24 business hours to start your application and gather the required verification forms.

If you have any questions, please contact
Email address *
What Grant Application are you Requesting for? *
Koj xav tau txoj kev pab cuam rau leej twg?
Title *
First Name *
Koj Lub Npe
Middle Name
Koj Lub Npe Nruab Nrab
Last Name *
Koj Lub Xeem
Phone Number *
Tug Xov Tooj
May We Text This Number? *
Data charges may apply. Koj puas kam peb ntaus ntawv tuaj rau tug xov tooj?
Email Address
We will be contacting this email address. (Peb yuav xa ntawv tuaj rau tug email koj sau.)
Street Address *
Include Apt. #, Ste. #, or Flr. # if applicable. (Chaw Nyob Txoj Kev)
City *
Lub Nroog
County *
Zip Code *
Mailing Address (If different from above)
Include Street, City, State, Zip Code (Yog hais tias koj muaj lwm qhov chaw nyob, sau rau hauv qab.)
What are the best times to contact you? *
Check all that apply. (Lub sijhawm twg thiaj zoo nrog koj tham? Nias tag nrho cov muaj feem.)
Early Morning
Late Morning
Late Afternoon
Type of Assistance *
Check all that apply. Additional verification may be requested on the application. (Hom Kev Pab Koj xav tau. Nias tag nrho uas muaj feem. Peb yuav cov ntaub ntawv pov thawj thaum koj ua koj daim ntawv thov tuaj.)
Additional Information and Comments
Puas muaj lwm yam koj xav hais qhia rau peb?
I understand that my information will remain confidential and that any information I have provided is true and correct. Please sign below.
Kuv nkag siab tias txhua yam kuv tau sau yuav tsis pub rau lwm tus pom thiab cov kuv tau sau no muaj tseeb thiab yog tas. Thov sau koj lub npe rau hauv qab.
Signature *
Kos/Sau koj lub npe.
A copy of your responses will be emailed to the address you provided.
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