Application for COVID-19 Rapid Response Funding

Question Title

* 1. First and Last Name

Question Title

* 2. Email

Question Title

* 3. Organization

Question Title

* 4. Organization Budget (approximate)

Question Title

* 5. Geography Served (select all that apply)

Alameda County

Contra Costa County

Merced County

Monterey County

San Benito County

San Joaquin County

San Mateo County

Santa Clara County

Santa Cruz County

Stanislaus County

Question Title

* 6. Program Officer

Question Title

* 7. Indicate your preference for how you would prefer to receive funding, if awarded:

Wire transfer

Check

Question Title

* 8. Please indicate the type of expense(s) for which you are seeking emergency financial assistance. Select one or more that are covered under your request.

Basic Overhead: Examples include occupancy and utilities payments

Infrastructure and Technology: Examples include hardware (laptops, hotspots, etc.), software (Zoom, Slack, etc.), and trainings to support remote/virtual work.

Program Growth: Meeting increased demands for services and programs

Program Shifts: Examples include adoption of new approaches, services and/or processes to achieve goals in response to the pandemic

Supplies and Services: Examples include health and safety equipment and deep cleanings/cleaning supplies

Workforce Support: Examples include additional staff costs, paid sick and family leave, and employee financial supports

Other (please specify)

Question Title

* 9. Please list the names and amounts of emergency funding you have secured or anticipate receiving from foundations or relief funds over the next three months (ex. ABC Fund - $20,000):

Source 1

Source 2

Source 3

Source 4

Source 5

Question Title

* 10. Please indicate the amount of funding you are requesting from us ($5,000 - $50,000):

Question Title

* 11. Optional - please include any additional information you would like us to know about the short-term, immediate expense(s) for your request (max of 500 characters).