LeRoy C. Merritt Humanitarian Fund Application
www.merrittfund.org
If you have any questions about the application or the grant process, please contact the Merritt Fund staff at (312) 280-4226 or merrittfund@ala.org.
First and Last Name
Your answer
Social Security Number
Your answer
Contact Information
Please include your mailing address, phone number, and email.
Your answer
Describe the Situation
To assist the Trustees, please describe in detail the situation resulting in your request for assistance and indicate how the situation relates to the purposes of this Fund. In your narrative description, please include the names of individuals involved in your situation and their roles in the events you have documented. Also, please specify the times and places for the events you have described, and include as attachments any supporting documentation(press reports, memos, etc.). Your narrative also should contain an explanation of the financial ramifications of your situation and explain why you are asking for the amount of aid you are requesting in this application.
Your answer
Legal Counsel
If you are presently represented by legal counsel, please provide counsel’s name and contact information. In addition, please ask your counsel to provide the Trustees with a brief overview of the legal issues in the case and the status of the case to date.
Your answer
References
Please include the names, relationship and contact information of three people from your local community who are familiar with your current situation. We recommend that these people not be members of your immediate family.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms