APPLICATION FOR ASSISTANCE
Please complete this form in its entirety. It is essential that you provide current and accurate information. Any documentation that you have that supports your claim should accompany this application to ensure there are no delays in evaluating your request. Please keep a copy of the completed form for your records. To qualify for a grant, you must be employed in a restaurant/hospitality establishment for 6 months. You must apply no later than 6 months after onset of need.
Grant payments will not be made directly to applicant; expenses will be paid directly to vendors. For example, if you are approved, we would pay rent directly to your landlord or management company or would pay your electric bill directly the power company. Grants will only be awarded to applicants who currently (or at the time of injury or illness) work at least part-time.