COVID19 Assistance Request
Requirements: You must be between 18 and 25 years of age, and reside in Northern Virginia*. This is a grant to be used for cost of living expenses, like utilities or cell phone or out of pocket emergency medical bills. If you have been approved, we will contact you. Be prepared to provide a copy of the bill you need assistance with. Grant amount maximum is $150. Limit is one grant per individual per month. NOTE: We may share your story across our social media, and will NOT use any personal information. We do this to bring awareness about how people have been affected by COVID19. (*If you are OVER 25 years of age, and require assistance, we can help. You are invited to apply, with the understanding that you may receive support in a different manner.)
Email address *
Name *
Your answer
Age *
Your answer
Pronouns (for example she/he/they) *
Your answer
Email address *
Your answer
Phone number *
Your answer
Town or City in which you currently live (or county) *
Your answer
Tell us about yourself. What is your family, living and income situation? *
Your answer
What do you need assistance with? *
Your answer
How did you first hear about Casa BruMar Foundation? *
Your answer
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