Request for Cash Assistance from The Stronger Together Fund
To request financial assistance from the Greater Attleboro Stronger Together Fund, please complete the form below. After this form is submitted, the referring agency will contact you at the phone number that you provided.
Who is the referring agency?
Client First Name
Client Last Name
Client Home Address
Is this request for an Individual or Household?
How have you been affected by the COVID-19 crisis? Select all that apply.
I left my job or am taking a "leave of absence" because I have the virus.
I lost my job because of the crisis and I am unemployed.
My hours were reduced at my job because of the crisis.
My spouse lost their job due to the crisis.
I am financially supporting people who have lost their job(s) because of the crisis.
How much financial assistance do you need right now? Select all that apply.
$50 Gift Card(s) for assistance with transportation, laundry, food, pharmacy, or a basic need
Another amount (please describe below)
If you need another amount, please write that amount here.
What do you need this money for? Check all that apply.
Transportation assistance with gas (Cumberland Farms)
Transportation assistance with bus pass (GATRA)
Laundry assistance (Laundry World)
Food assistance for a special dietary need (Stop & Shop)
Pharmacy assistance (Walgreens)
Basic Supply assistance (Walmart)
Rent owed, mortgage owed, or security deposit
Child care expenses
Basic utilities and supplies, such as Internet for families with school-age children
Oil delivery or utility expenses (referral may be made to Self Help or SVdP, as available)
What is the best phone number to reach you?
How were you referred to The Stronger Together Fund?
House of Worship or a Faith-Based Partner of Attleboro Area Interfaith Collaborative
Food n' Friends program of Attleboro Area Interfaith Collaborative
Resource Junction program of Attleboro Area Interfaith Collaborative
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