Accelerate Hope Fund Application Form

Section 1 : Applicant Information

Employee Name

Employee ID

Department

Job Title

Email Address

Phone Number

Phone

Section 2: Hardship Details

What happend?

What do you need help paying for?

Hardship Description

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

Urgency of the Situation

Section 3: Financial Request

Amount Requested

Other Resources Explored

List any other sources of assistance applied for or received.

Section 4: Supporting Documentation

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

Drop your files here

Comments about documentation

Section 5: Acknowledgements

Have you applied to the Accelerate Hope Fund before?

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