EMERGENCY ASSISTANCE REQUEST FORM

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tenstrongthousand@gmail.com
Phone number
(704)-910-7628

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EMERGENCY ASSISTANCE REQUEST FORM

10000 Strong > EMERGENCY ASSISTANCE REQUEST FORM

EMERGENCY ASSISTANCE REQUEST FORM

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Applicant Name:(Required)

Member Since:

Type of Hardship:(Required)

Housing

Utilities

Medical

Transportation

Employment

Other

Description of Situation:

Please describe the hardship, when it occurred, and why assistance is needed.

Amount Requested:(Required)

Recovery Plan Statement:(Required)

Describe steps you are taking to stabilize your situation.

I understand assistance is discretionary and not guaranteed.(Required)

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(704)-910-7628
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tenstrongthousand@gmail.com
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10,000 STRONG is a program of Freedom Foundation Inc., a 501(c)(3) nonprofit organization. EIN: 84-2897233. Assistance is not guaranteed and is subject to review, eligibility, and availability of charitable funds. This program does not provide insurance or contractual benefits.

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EMERGENCY ASSISTANCE REQUEST FORM

EMERGENCY ASSISTANCE REQUEST FORM

Non-Entitlement Language

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