Haven membership subsidy request form for May
What is your name? *
Your answer
What is your email address? *
Your answer
What is your membership level? *
What level of subsidy are you requesting for May? *
What type of worker are you? *
What type of business loss have you experienced? *
This is for aggregate purposes only - we are getting asked about the financial impact on our members from outside sources and would like to have a sense of how this crisis is impacting our membership.
Any additional questions or comments?
Your answer
Please type your name to certify that you are experiencing financial strain during this time and need a temporary subsidy in order to continue your Haven membership, and that you understand that you will need to reapply for a subsidy each month.
Your answer
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