Beth Am COVID-19 Emergency Relief Grant Request Form

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Emergency grants are made to Beth Am members who have lost income due to the COVID-19 crisis and need assistance paying for basic necessities such as housing, food or medical care. At this time, grants are one-time. Depending on the demands on the fund, and the depth of the funds available, additional grants may be offered at a later date.

First Name

Enter the submitter's first name

Last Name

Enter submitter's last name

Email Address

Phone Number

Street Address (to mail grant to)

City

State

Zipcode

Please list the names and ages of the people who are currently in your household.

Please briefly describe the nature of your need, and the impact that the COVID-19 crisis has had on your income stream:

Thank you for completing this request form. Click on the "Submit" button to complete this submission.

Wed, January 19 2022 17 Sh'vat 5782