Baruch Community Housing Relief Grant
Eligibility Criteria
Applicants must be seniors aged 65 years or older
Applicants must move into an assisted or independent living community within 60 days of applying for the grant or already reside in an assisted or independent living community.
The applicant must agree to provide any follow-up information regarding the information submitted as part of the application process.
Terms & Conditions:
Grants are awarded on a first-come, first-served basis, subject to the availability of funds.
Recipients may only receive this grant once within 12 months.
Funds cannot be transferred, deferred, or exchanged for other services or cash.
Grants will be disbursed directly to the senior living community on behalf of the grant recipient.
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Demographic Information for Senior Applicant
1. First Name *
*
2. Last Name *
*
3. Date of Birth (mm/dd/yyyy): *
*
-
Month
-
Day
Year
Date
4. Current Address *
*
5. Contact Phone Number *
*
Format: (000) 000-0000.
6. Email *
*
example@example.com
7. Representative Name(if someone is assisting the senior in completing this application)
8. Representatives relationship to the applicant (son, daughter, grandchild, neighbor, friend, etc.)
9. Representative Phone:
Format: (000) 000-0000.
10. Representative Email
example@example.com
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Senior Living Community Information
11. Are you in the process of moving into an assisted living or independent living community within the next 60 days? Or do you currently reside in an assisted living or independent living community? *
*
Yes
No
12. Community Name *
*
13. Community Address *
*
14. Community Phone Number (leave blank if unknown)
Format: (000) 000-0000.
15. Community Contact Name *This contact will confirm the seniors eligibility
*
16. Community Contact Email *This contact will confirm the seniors eligibility
*
example@example.com
17. Community Contact Phone (leave blank if unknown)
Format: (000) 000-0000.
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Financial Information
18. Provide a brief description of your financial situation demonstrating your need for the senior living community microgrant *
*
19. Describe how this micro-grant will assist you in moving into or remaining in a senior living community *
*
Hardship letter
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Eligibility Criteria Confirmation
20. I confirm that I am aged 65 years or older.
*
Yes
No
21. I confirm that I am facing financial constraints that affect my ability to cover rental cost to transition into or remain in a senior living community.
*
Yes
No
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Declaration and Signature
22. How did you hear about Baruch's Senior Living Community Micro-Grant?
*
24. I declare that the information provided in this application is true and accurate to the best of my knowledge. Type YES below.
*
25. I understand the terms and conditions of the Micro-Grant for Seniors and agree to adhere to them. Type YES below.
*
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Testimonial Agreement
26. As a recipient of the Micro-Grant for Seniors, I agree to provide a written or verbal testimonial about my experience with the grant and its impact on my transition into or remaining in a senior living community. I understand that this testimonial may be used by Baruch Senior Ministries for marketing and promotional purposes to help continue the availability of this grant for others. Type YES below.
*
Submit
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