Mad River Valley Community Fund Application

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This short form application was created in response to Covid 19 concerns. In an effort to bridge the gap between layoffs and receipt of unemployment benefits we have created an expedited financial support process. Please fill this out and select submit.

Email *

Please provide your name *

Please provide your physical address *

Please provide your mailing address *

Please provide your main contact number *

Please list who shares your home with you. Please list the age of each person/child who lives with you. If no one shares your home please indicate this. *

How has your income/family been impacted by Covid-19 pandemic? *

Who was/is your employer and their contact information? *

Please indicate the date of your application. Thank you! Someone will get back to you shortly. *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

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This form was created inside of Harwood Unified Union School District.

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