COVID-19 FINANCIAL ASSISTANCE FUND - Project Ezrah

As a result of this crisis, Project Ezrah has developed a special fund to assist Bergen County community members whom have been financially impacted by Covid-19 and are in need of additional assistance. This program provides a one time distribution of up to $2,000 per eligible family.  If you already got assistance through this fund but are still having difficulties due to inpacts from Covid-19 you are welcome to apply again.



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Email *
Last Name? *
First Name? *
Marital status *
Required
Spouse's First Name?
Spouse's Last Name?
Home Address ? *
City? *
State? *
Zip Code? *
Home Telephone Number? *
Cell Number? *
Spouse's Cell Number?
Shul Daven at and/or Rav's Name? *
Total Number of Household Members Living at Home before Covid-19? *
Total Number of Household Members Being Supported (children, parents, grandparents) since Covid-19? *
Employer *
Occupation *
Spouse's Employer
Spouse's Occupation
Reason For Request? *
Are you receiving unemployment? *
If you are unemployed, provide the date you last worked.
Amount of Request up to $2,000 *
Provide your total MONTHLY income including gifts, parental support, etc. PRIOR to Covid-19 *
Provide your total CURRENT MONTHLY income including gifts, parental support, etc. *
Provide the total CURRENT balance in your checking, savings, and bank accounts. *
Provide the total CURRENT balance in your retirement accounts. *
List other sources of Financial Assistance. *
Are you receiving any other communal assistance in 2020 or 2021? (e.g. Maos Chitim/Passover Fund, etc.) If yes, please explain (Note: You are still likely eligible for funds, even if you do receive from other sources) *
Are you interested in any other assistance?
*
Required
Project Ezrah reserves the right to contact your Rabbi and for those who  prefer to not complete this form, call Rachel Krich directly at Project Ezrah -  201-569-9008 or email Rachel@ezrah.org.
A copy of your responses will be emailed to the address you provided.
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