LIFT Mercy Fund Application
COVID-19 Related Emergency Assistance Application
Name *
Email
Address *
Phone number *
How has your situation been impacted by the COVID-19 pandemic, either directly or indirectly? *
Required
If "other," please explain
Assistance Requested *
Required
Please explain in further detail the assistance you are requesting, so we can better understand your needs. *
How soon do you need these services? *
What additional assistance, if any, do you need? Please be as specific as possible including the frequency and urgency.
Submit
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