Relief Fund Application




Date
Applicant Name:
Applicant Address
Email Address:
Candidate(s) Name (If different from applicant.)
Briefly Explain the Reason for the Funding Request
If you are applying on behalf of someone, how is this person(s) connected to you?
If your request is accepted for further consideration, the administrators of the Relief Fund will request an interview with you to more fully understand the nature of your request.
Where a decision is made by the Administrators to proceed, the appropriate type of financial assistance will be decided by the Administrators i.e. whether assistance in the form of either a ‘gift’ or a ‘loan’ would be more appropriate in the particular situation and what the terms may be.
There is a general preference that any disbursements from the Relief Fund be paid directly to a nominated third party to whom the applicant is or is about to be indebted.
This form will be directed to the administrators of the Relief Fund, Elgin Graham, elginnz@gmail.com
Amount of Funding Requested:
Do you want this to be kept anonymous? Yes
No
Notsure, would like to speak talk to someone about this.
By ticking the box I agree that this will be considered my electronic signature. Yes, I agree that this will be considered my electronic signature.

 


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