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Who We Help
Board of Directors
FOR THE CHILDREN, INC.
COVID 19 Emergency Assistance Application
How many children under 18 living in the household?
Name of employer (former if laid off):
Are you able to verify employment if needed? (Pay stub, letter from employer, etc?)
Date of lay off or reduced hours:
Date Format: MM slash DD slash YYYY
Estimated income loss:
Please describe briefly your reason for applying:
I attest that the above information is accurate and correct