United Ways of
Northern New Jersey and Hunterdon County

ALICE RECOVERY FUND

EMERGENCY ASSISTANCE APPLICATION

 
 

Now, we will need to obtain some more important information and documents about you and your family. Please fill out the form below to get started. Note: because we will require you to attach and submit important files/documents (e.g. proof of income, proof of termination of job), you may want to gather them ahead of time.

(* Denotes required fields.)

APPLICANT CONTACT INFORMATION

Please type answers to all questions.
First name is required.
Last name is required.
Valid email address is required.
Home street address is required.
City or town is required.

State:

New Jersey

Zip code is required.
Phone number is required.
County is required.

HOUSEHOLD SIZE

Are you applying as: *

Who is supported by your income? (Include yourself and household members who rely on your income.)
Please enter the name of someone whom your income supports.
Age of person:
Please enter the relationship of someone whom your income supports.

Household Member 2
Age of person:

Household Member 3
Age of person:

Household Member 4
Age of person:

HOUSEHOLD INCOME

What was the total 2019 income in your household prior to the COVID-19 pandemic? (Please fill in for all household members, including yourself, who worked prior to COVID-19. Additional persons can be added.)
Please enter the name of the person for whom you are reporting total income.
$
Please enter the amount (in U.S. dollars) of income prior to unemployment.
Check if*

Household Member 2
$
Check if

Household Member 3
$
Check if

How much has the total income in your household decreased as a result of the COVID-19 pandemic? (Please fill in for all household members who lost income.)
Please enter the name of the person for whom you are reporting the income decrease.

Household Member 2

Household Member 3

Required Documentation

Please Upload:
Please attach/upload your proof of income file/document.
Please Upload:
Please attach/upload your proof of termination file/document.

We understand not all income can be verified by standard documentation. Don't worry, we are here to help! You may still be eligible for assistance from the ALICE Recovery Fund - please email us at ALICEfund@UnitedWayNNJ.org, or call 973.993.1160, x700 to discuss alternate ways to verify your income.


CONSENT

By filling out this application, you are hereby giving permission to United Way of Northern New Jersey, United Way of Hunterdon County to use your information to evaluate this application for assistance. All information provided as part of this application will be kept confidential except for the purpose of evaluating eligibility.

If approved for this assistance, are you willing to share how the ALICE Recovery Fund helped you financially to help us promote the Fund with donors and the media?*
By signing below, I acknowledge that I/my household has had a reduction in income due to the COVID-19 pandemic. I further acknowledge that all the information provided in this application for assistance is true and complete.
Enter your full name including your first and last names.
Your full name (including your first and last names) is required for your electronic signature.
Choose from popup calendar, or enter date YYYY-MM-DD in format.
Today's date is required for your electronic signature.
 
 

Participation in promotion is not required to receive funding. 


ANTI-DISCRIMINATION AND ANTI-HARASSMENT POLICY

The policies and practices of United Way of Northern New Jersey, United Way of Hunterdon County are to accept requests, provide service and assistance, and make decisions without discrimination because of gender, gender identity, transgender status, sexual orientation, perceived sexual orientation, race, ancestry, religion, national origin, age, medical condition, disability, marital or civil union status, veteran status, citizenship status, source of income or other protected group status and to treat all persons requesting assistance equally and fairly. In keeping with this commitment, United Way of Northern New Jersey, United Way of Hunterdon County will not tolerate harassment of applicants by anyone, including staff and volunteers of United Way of Northern New Jersey, United Way of Hunterdon County.

Harassment consists of unwelcome conduct, whether verbal, physical, or visual, that is based upon a person’s protected status, such as gender, gender identity, transgender status, sexual orientation, perceived sexual orientation, race, ancestry, religion, national origin, age, medical condition, disability, marital or civil union status, veteran status, citizenship status, source of income or other protected group status and to treat all persons requesting assistance equally and fairly.