Saheli Economic Empowerment Form
Saheli's Economic Empowerment funds are designed to provide South Asian domestic violence survivors financial aid that will help them move towards a financially independent and self-sustaining life. Please note that there are only a limited number of grants. Saheli will make a decision based on the needs and projected impact of the aid.

The survivor will be required to submit a report on how the aid was utilized and how it helped 3 months after receiving the funds.
Name *
Email
Phone
Current Address *
Who are you living with? *
Do you have children? How many?
Saheli provides fund ranging from $250 to $2000. What amount are you requesting? Please note that the amount granted will be at Saheli's discretion. *
Please indicate which of these areas will the funds be used for: *
Required
Please give a description on how you will use these funds to pursue your financial goals. *
Please provide a detailed budget and activities with a timeline *
What is your income category? *
You will be required to attend Saheli's Financial Literacy sessions in the Fall and Spring. Will you be able to do so? *
Is there anything else you would like to tell us?
Thank you for time!
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if my application for assistance is accepted, any false statements, omissions, or other misrepresentations made by me may result in my immediate disqualification.
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