Mi Gente Community Emergency Fund Grant Application
*Si desea completar este formulario en español, haga clic aquí: https://forms.gle/cAxPEBRAq4xm9M6y5

Latino Motion is committed to supporting the well-being of working-class families in Atlantic County, New Jersey. In response and in collaboration with other trusted community-based and grassroots non-profit organizations, the MI GENTE COMMUNITY EMERGENCY FUND was established to aid the most vulnerable Atlantic County residents that are currently suffering from severe financial instabilities as a result of the COVID-19 pandemic

The application will close on Friday, July 17, 2020.

Emergency financial assistance is available for people who are unable to pay basic living expenses like rent and utilities, and to pay for expenses due to medical issues & necessary health supplies. People with dire and proven financial needs, due to the COVID-19 pandemic, are encouraged to apply and may qualify for a $350.00 grant from this emergency fund.

We ask that if this is not an emergency, please wait to apply. These are unprecedented times and we want to award our resources to those truly in need.

All data is kept confidential and secure.

Due to this pandemic, we are expecting an overwhelming number of applications for emergency financial assistance from the MI GENTE COMMUNITY EMERGENCY FUND. We will be working diligently to process applications, and we ask for your patience. Your application could take two-three weeks to process. Please know that you are our primary concern, and we will respond to applications as quickly as we can.

If you have any questions, please contact us at 609-878-8171 or email us at nj@migentefund.com.

Thank you for your understanding and please be safe.

First Name *
Last Name *
Phone Number *
Email Address
Street Address *
City *
State *
Zip Code *
Are you currently working? *
If you are not working, did you lose your job due to the COVID-19 crisis? *
If you did lose your job due to the COVID-19 Crisis, when did you lose your job?
MM
/
DD
/
YYYY
If you are or were working before the COVID-19 crisis, where do/did you work?
What is/was your position title at work?
How long have you worked there? *
What was your hourly wage, including tips, before the COVID-19 crisis? *
How many people live in your household, including you? Please include the number of children and other adults you support financially. *
Can you currently afford to make your next rent or mortgage payment? *
Does your family have enough to eat right now? *
Do you qualify for government benefits such as unemployment insurance? *
Please describe to us your current financial hardship (please list all of your financial needs and/or bills and the amount needed/owed--be as specific as possible): *
If asked by the selection committee, are you able to provide documentation of the bills, rent, or mortgage you need to pay? *
PLEASE SELECT YES BELOW TO AFFIRM: Latino Motion is a 501(c)(3) charitable organization, which has established a financial assistance program to help those affected by COVID-19. By applying to the MI GENTE COMMUNITY EMERGENCY FUND you: (1) authorize Latino Motion to share your information with the selection committee members of the MI GENTE COMMUNITY FUND (2) confirm that you have not provided any false information on this application that would affect your eligibility to participate in this program (3) agree that Latino Motion or the selection committee from the MI GENTE COMMUNITY EMERGENCY FUND are not obligated to award you a grant, which will be distributed to beneficiaries based on a combination of factors including order of application, need, and availability of targeted or general funds, and (4) you agree to write a statement thanking the donors to the fund and the selection committee. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms