United for Veterans Crisis Fund Application | United Way of Northeastern Minnesota

The purpose of this application is to request approval for funding support to cover basic living expenses. The following information requested will be used to determine your personal financial situation and what your needs are. All requests will be reviewed by a committee of 2-3 staff from the United Way of Northeastern Minnesota and remain confidential. Grants cannot be processed without the form completed in full. Please note that completing this paperwork does not guarantee the request will be approved.

Maximum Request Amount: $500 a year per person/family.

INSTRUCTIONS:

Section One – Personal Information: Complete ALL information requested

Section Two – List of bills to be considered for payment: Please note, United Way does not make contributions to individuals. Payments will be made directly to the creditor. A copy of the current bill requested for consideration should be uploaded.

Section Three – Reason for Request: Please provide a narrative stating the reason for your request, what caused the hardship and what you will or are doing to make sure the issue is resolved.

Economic Analysis – This is a simple budget to determine your monthly income and expenditures. Be precise and inclusive when completing this.

Under Section A: Present Financial Resources include:
- ALL INCOME for the month
Under Section B: Basic Living Expenses include:
- ONLY current month expenses; AND
- If a bill is in arrears and due in full, the participants needs to work out a payment plan with the creditor to get the bill paid off – whatever that monthly amount is can be used as a Basic Living Expense
- Food and transportation estimates can be used as follows:

                                                FOOD ESTIMATION:
  Single person                        -               $250.00
                                                Family of 2                            -               $477.00
                                                Family of 3                            -               $572.00
                                                Family of 4                            -               $860.00
                                                Over 4                                    -               add $100.00 each addt’l person
                                (Official USDA Food Plans: Cost of Food at Home at Four Levels, U.S. Average)

                                                TRANSPORTATION ESTIMATION:    $.575 per mile

REQUIRED back-up documentation:

Copies of most recent monthly income statements
Copies of actual current month’s bills requesting consideration for payment
Copies of most recent bank statement/s
Copy of DD214

Section One

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Birth Date

Marital Status

Single

Married

Number of Children &/or Step-Children

Ages of Children &/or Step-Children

Current Place of Employment

Who were you referred by?

When did you serve? (MM/YY - MM/YY)

Branch

Section Two

Requesting consideration for payment on the following:

One file only.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Section Three

Reason for Request

Economic Analysis

Please click here to download the Economic Analysis. Fill it out & save it as "[YOUR NAME] Economic Analysis" then upload it below.

Upload Economic Analysis

Back-Up Documentation

Copies of Most Recent Monthly Income Statements

Copies of most recent bank statements

Copy of DD214

Please click here to download the release of information, save it as "[YOUR NAME] Release of Information" and upload it below.

Upload Release