Hayward Family Support Grant Application
The Family Support Grants are a program of the Hayward Community Relief Fund, sponsored by the City of Hayward and administered by La Familia, a local nonprofit based in Hayward.
The Grant Program will provide $500 grants to Hayward families who have lost income as a result of COVID-19 and the Shelter-in-Place orders and are ineligible for unemployment insurance and federal relief programs. The Hayward Community Relief Fund believes all residents in our community should have access to financial support during this difficult time.
Funds are limited based on the money we are able to raise. Grants are limited to one per family. Grants will be awarded though a lottery.
First Name & Middle Name *
Full Last Name *
Home address (including street number, street name, and apartment or unit number where applicable) *
City *
Zip Code *
Can you receive mail safely at this address? *
Can you receive mail safely at this address? *
If you answered “No” to the question above, please provide a safe address to send mail.
Email (Optional)
Telephone Number / Cell phone Number *
How many adults (18 or older) in your household depend on your income? *
How many children (under the age of 18) in your household depend on your income? *
Employment Background: Are you currently employed? *
Where do/did you work and what is/was your most recent job or position? *
What type of industry do/did you work in? (Please check all the boxes that apply) *
Did you lose your job as a result of Coronavirus/COVID-19 or the Shelter in Place Order? *
Were your hours cut as a result of Coronavirus/COVID-19 or the Shelter in Place Order? *
Unemployment Insurance is a benefit available to workers who (1) have lost their employment through no fault of their own, including because of the Coronavirus and (2) have work authorization in the US. Do you qualify for unemployment insurance? *
Have you received any relief from the federal government? *
If you answered yes above, please specify which federal relief funds you have received:
Financial Need: Please share with us how the Coronavirus pandemic and shelter in place order has affected you and the members of your household. *
Please identify the items you are struggling to pay for, due to Coronavirus/COVID-19 and the Shelter in Place order:
Have you applied for Coronavirus/COVID-19 relief grants through any other organization? *
Have you received Coronavirus/COVID-19 relief grants through any other organization/s? (i.e. relief funds other than Hayward Community Foundation fund) *
If you answered yes above, please specify which Coronavirus/COVID-19 relief grants you have received:
Has anyone else in your household applied for a Hayward Family Support Grant? (spouse, partner, roommate etc.) Please write their name. *
Connecting with Organizations: How did you hear about the Hayward Family Support Grants? *
Do you want to get information about additional resources available during COVID-19? (if you answer "Yes," information will be sent to the email address you provided) *
Final Steps: Hayward Community Foundation Fund is made possible by generous donations from hundreds of donors to help those most in need. Do you declare under penalty of perjury that all the information you have provided is true and honest to the best of your knowledge and belief? *
Additional information unrelated to your qualifications to receive a grant: Do you want to be added to our list of available volunteers to help support efforts around COVID-19, such as food distribution? Your participation will not be linked to this application.
Clear selection
If you have not already, please consider taking the 2020 Census. The census is completely confidential and allows Hayward to receive funding for important social service programs. (No response required)
Never submit passwords through Google Forms.
This form was created inside of La Familia Counseling Service. Report Abuse