COVID-19 Emergency Community Fund
A Project of Achiezer Community Resource Center
This project is in Conjunction with:
Last Name: *
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Applicant First Name: *
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Spouse First Name: *
Your answer
Street Address: *
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City *
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Email Address: *
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Contact Phone Number (this is the way we will reach out to you): *
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Shul Affiliation: *
If Shul is not in drop down list, please specify:
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Has your income been impacted by the Coronavirus crisis? *
If your income has been impacted, please describe how:
Your answer
How many adults in the family (including applicant and spouse)? *
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How many children in your home? *
Your answer
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