Accelerate Hope Fund Application Form

Section 1 : Applicant Information

Employee Name*

Employee ID

Department*

Select

Job Title*

Email Address*

Phone Number*

Phone

Nature of Hardship*

Select or enter value

"Other" explaination*

Hardship Description*

Provide details about the hardship, its impact, and how the funds will help.

Urgency of the Situation*

Select or enter value

Amount Requested*

Other Resources Explored*

List any other sources of assistance applied for or received.

Upload Supporting Documents*

Examples of Required Documentation (non-exhaustive):

Photos of damage
Personal financial statements (verification of family income and expenses; other available assets)
Insurance claims, explanation(s) of benefits and deductibles
Police reports
Repair estimates with readily verifiable contact information
W-9 of creditor to whom a payment is being issued. The W-9 is necessary for AHC to issue funds to a creditor on an employee's behalf
Receipts of incurred expenses
Overdue billing statements
Certification of medical condition
Certificate of death
Medical bills
Funeral costs/estimates

Drag and drop files here or

Comments about documentation

Have you applied to the Accelerate Hope Fund before?*

Select

If yes, provide details*

I confirm that the information provided is accurate and complete to the best of my knowledge.*

I understand that submission of an application does not guarantee approval.*

Send me a copy of my responses