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Capital Area COVID-19 Community Response & Recovery Fund - Family / Individual Application

Invalid Submission Values

    Applicant Information

    Do you receive SNAP/WIC benefits? (required)
    Is anyone in your household pregnant? (required)
    Do you have children under 18 in your household? (required)
    Do you receive housing assistance? (required)
    If yes, are you requesting additional housing assistance?

    Emergency Funding Request
    I understand that this application, if approved, represents a one-time assistance payment, to help in a financial emergency that has arisen due to the restrictions put in place by federal, state, and local governments regarding the COVID-19 pandemic.

    I understand Capital Area United Way may approve up to $500, as needs and funds allow. Funding maximum of $500 is available to one per family/household.

    I am furnishing accurate information to the best of my ability. I understand that falsifying information will disqualify me for assistance. I authorize the Capital Area United Way to furnish and request information from others in order to obtain help that I need.

    Example: ##/##/####