JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Black Stimulus Package Relief Form
We are providing micro-grants to People of African Descent in the NYC community negatively and financially affected by the Coronavirus pandemic. Fill Out the form and we will follow up with you in regards to the next steps.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Organized by NYC-Universal Negro Improvement Association & African Communities League
Name
*
First and last name
Your answer
Phone number
*
Your answer
Email
*
Your answer
Are You of African descent?
Yes
No
Clear selection
What languages do you speak?
Your answer
Contact Method #1
Your answer
Contact Method #2
Your answer
List Your FULL ADDRESS (shelters, group homes, address where you get mail) We need an address for accounting purposes)
Your answer
Who is Applying for this Relief Grant?
Individual
Freelancer
Small Business Owner
Clear selection
How has the Coronavirus pandemic impacted your livelihood?
Your answer
How will you use the grant money?
*
Food & Supplies
Pay Minor Bills
Contribute to rental/mortgage payments
Other:
Required
If You have an Questions, Comments, or Concerns regarding this form email us at "
UNIAnewyork@gmail.com
". We will contact you shortly upon completion of this relief form.
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy