Request for Financial Assistance
Black America Cares (BAC) is a 501(c)(3) nonprofit serving people facing a temporary financial crisis. Due to funding restrictions, all clients must be a PG County, Maryland resident. When more funding becomes available, we will be able to extend our assistance to more areas. Proof of residence is required.  
All information provided is strictly confidential and will not be shared.
Please note that all requests for assistance cannot be fulfilled and will be based on funding availability.
Monetary donations help us provide assistance to people like you. 
Please consider donating when you can. 
First and Last Name *
Current Address *
Email *
Phone number (Ex. 123-456-7890) *
Have you applied for assistance through Social Services or any other organization? *
If yes, what organization did you request assistance from? *
Are you currently employed? *
In 50 words or less, describe your problem. *
Provide the company name, phone number and the account number of the bill you need help with. 
(Note: We never give money to the client. We pay the company directly) *
How much is the bill you owe?  (How much are you requesting?) *
Please briefly describe the reason for your financial hardship. (50 words or less) *
Do you have proof of this bill? Please provide a copy of the bill or letter from the company you owe and email it to blackamericacares@gmail.com. Make sure your name and current address is on it. *
If we are able to assist you, describe how it will help you. What will be the result of getting this assistance from BAC?
 *
What is your Social Media Page Handle? ( ex.Facebook, Twitter, Instagram) *
Have you ever donated to BAC or any nonprofit organization? If yes, which one? *
By submitting this form, you certify that all of the above information is correct.  You understand that BAC's financial assistance fund is limited by our budget and ability to fundraise. 
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