Mano a Mano Mutual Aid Fund Application | Columbia County Sanctuary Movement CRM

This is the application for first-time recipients. If you have already received funds from Mano a Mano and are applying for a second round, click on this link.

Date of Application *

First Name *

Last Name *

Preferred Language

Address

Street and Number *

City / Town *

ZIP Code *

State

New York

Country

United States

Pronouns *

Date of Birth (month/day/year) *

Country of Origin *

Phone Number *

How do you identify? (Check all that apply)

If you marked "other", please explain

How many people live in your household? *

How many people in your household are dependents? *

What are their ages? *

If your children are in school, which school do they attend?

Are you currently working? *

Yes No

Were you working prior to COVID 19? *

Yes No

Where are you/did you work? *

How many weeks have you been without paid work?

If you are still employed, how many days a week are you working?

If you are not working, when do you think you will return to work?

Your response to this question will be the primary source of information for our decision to give funds. Please give as much detail as possible.

Why do you feel your situation is especially difficult? *

Please share how the immigration crisis and/or COVID crisis has affected you and your family *

Amount You Are Requesting from CCSM *

Note: CCSM can provide a maximum of $300 to each recipient. If your need is greater, we will try to obtain further support.

Total Amount Needed (if different than amount above) *

Are you or do you expect to be receiving other COVID related support, such as a stimulus check or unemployment? *

Have you worked with or received services from CCSM before? *

Yes No

If so, how or which ones? *

Can we add you to our email list for future notifications and alerts? *

Yes No

Can we add you to our text list for future notifications and alerts?

Yes No

Certification *

I certify that all of the information contained in my application is true.

Receive A Hand Today, Give A Hand Tomorrow. If your financial circumstances change in the future and you are able to contribute to CCSM’s “Mano a Mano” Mutual Aid Fund, please consider making a donation in an amount that feels meaningful to you so we can all continue to support other community members in need. You can make a donation at sanctuarycolumbiacounty.org/donate.

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