Grant Application

PEOPLE FOR PEOPLE FOUNDATION
Southern New Jersey Residents Only
Date of Application*
Personal Information
First Name*
Last Name*
SSN*
Age*
Email

Enter Email

Confirm Email
Phone*
Alternate Phone
Spouse Information
Spouse Name
Spouse SSN
Spouse Age
Address Information
Street Address*
Street Address 2
City*
State*
Zip Code*
County*
How long at this address?*
Do you own or rent?*
- Own
- Rent
Monthly mortgage/rent
Past due amount

Employment Information
Are You Employed?
Employer Name
Length of employment
Unemployed, how long?
Occupation
Is Your Spoused Employed?
Spouse's employer name
Spouse's length of employment:
Spouse unemployed, how long
Spouse's occupation

Household Composition
Number of Adults
List Adults in Household & SSN
Number of Children under 18
Ages of Children
Monthly Gross Income*
Are you receiving TANF / General Assistance?
- Yes
- No
Are you a veteran?
- Yes
- No
Are you receiving other Government assistance?
- Yes
- No
Reason for Grant
Why do you have this need?
Dollar Amount Requested?
What is the Total Debt?
Debtor:
Account number:
Contact person:
Debtor phone number:
Debtor address:

Who can verify your need? (Caseworker, clergy, Supervisor, or Community Leader)
Name and title:
Agency:
Phone number:

Referred By
Name and title:
Agency:
Phone Number:
Authorize:
- Agree
By clicking this box, I stipulate that the information provided is true and accurate. I authorize People for People to use this information to verify my application. I also grant permission to People for People to contact other agencies and help providers concerning my application. I understand that the circumstances listed above may be reproduced in the future, however no names will be used unless permission is granted by the applicant.
Decision
UTILITY INFORMATION
Email

This field is for validation purposes and should be left unchanged.