APPLICATION FORM: Urban Indigenous Temporary Pandemic Response Fund 2020

About the Urban Indigenous Temporary Pandemic Response Fund

The intention of this fund is recognize the financial impact of COVID-19 on Urban Indigenous People and support essential needs.

In order to assist and alleviate the challenges presented to urban Indigenous individuals and families as a result of COVID-19 pandemic, the Urban Indigenous Temporary Pandemic Response Fund is available.

The fund supports three areas of identified essential need at this time:
1. Reducing barriers to accessing government funding and social services supports
2. Health, safety and wellness
3. Food security and basic necessities for families.

How it works

This fund will be reviewed by a volunteer COVID-19 response committee.

To ensure confidentiality and fairness, all applications will remain anonymous to the volunteer COVID-19 approval committee. Please do not provide your name on your application.

Please wait to be contacted via phone if you have been deemed eligible by the committee.

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* 1. I have read and agree with the following statements (please check):

All information I provide in this application will remain strictly confidential.

Friendship Centre Employees will not be involved with the application or volunteer COVID-19 response committee.

My application will be anonymous during the approval process.

Approval of my application is based on the information I provided in my application, my eligibility and level of need.

This fund is discretionary and subject to change based on the continually evolving COVID-19 situation.

I understand that funds are limited and there will simply not be enough funds for all applications. The volunteer committee will make every reasonable effort to provide support to as many families we can through this fund.

I understand that the outcome of my application is confidential and must not be shared.

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* 2. Please provide us with your personal information. All answers must be completed in full.

NOTE: We reserve the right to request more information including documentation to show proof of information provided.

Are you Indigenous/Metis/Inuit and living off reserve? Type 'YES' or 'NO'

Mailing Address:

Physical Address:

Community where you live (Smithers, Telkwa, Houston):

Date of Birth:

Name of Nation:

Name of Band:

Status Number (Write NA if Not Available):

Your Phone Number:

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* 3. Please provide us with the following information about your financial situation:

Are you currently employed? YES/NO

Please list any government benefits you are receiving: E.g. social assistance, CPP, Child tax benefit):

What is your monthly income (wages, government benefits):

Is another adult member of your household also submitting an application:

What are your total monthly shelter expenses (Including rent, hydro)

How many dependent children are living at your address:

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* 4. The Urban Indigenous Temporary Pandemic Response Fund is available to support three identified areas of essential need.

Category One: Reducing barriers to accessing government funding and social services supports (You can apply for up to $200)

Eligible expenses:

Professional tax services to ensure taxes are filed on time to reduce barriers to receiving government benefits such as EI, CERB etc.

Costs of ensuring ID and documentation required to access government benefits e.g. BCEID, Birth Certificate etc.

Cost of obtaining drivers license.

Category Two: Health, safety and wellness (You can apply for up to $150)

Eligible expenses:

Prescriptions (not covered by medical benefits)

Counselling and mental health services (not covered by medical benefits)

Essential medical expenses

Category Three: Basic necessities for families (You can apply for up to $50)

Eligible expenses:

Food

Essential items to reduce spread of COVID-19 (personal and home cleaning items, hand sanitizers, masks)

Personal and child-related hygiene items (hygiene, soap, food safe, shampoo, toothbrushes, diapers, wipes)

Clothing and bedding

PLEASE SELECT WHICH CATEGORY YOU ARE APPLYING FOR:

1. Reducing barriers to accessing government funding and social services supports (up to $200 available)

2. Health, safety and wellness (Up to $150)

3. Basic necessities for families (Up to $50)

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* 5. Please help the selection committee understand your need by describing the challenges you face and reasons you are applying for this category.

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* 6. Please write a list of what you will be using the funding support for based on eligible costs for your chosen category.

Category One: Reducing barriers to accessing government and social service supports (You can apply for up to $200)

Eligible expenses:

Professional tax services

Costs of ensuring ID and documentation required to access government benefits e.g. BCEID, Birth Cert etc.

Cost of obtaining drivers license.

Category Two: Health, safety and wellness (You can apply for up to $150)

Eligible expenses:

Prescriptions (not covered by medical benefits)

Counselling and mental health services (not covered by medical benefits)

Essential medical expenses

Category Three: Basic necessities for families and elders (You can apply for up to $50)

Eligible expenses:

Food

Essential items to reduce spread of COVID-19 (personal and home cleaning items, hand sanitizers, masks)

Personal and child-related hygiene items (hygiene, soap, food safe, shampoo, toothbrushes, diapers, wipes)

Clothing and bedding

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* 7. How much are you applying for?

$200 (Category One)

$150 (Category Two)

$50 (Category Three)

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* 8. Please provide any additional information that you wish the selection committee to know. Do not include names of yourself or family members to ensure your application is anonymous.

APPLICATION FORM: Urban Indigenous Temporary Pandemic Response Fund 2020

Question Title

* 1. I have read and agree with the following statements (please check):

Question Title

* 2. Please provide us with your personal information. All answers must be completed in full. NOTE: We reserve the right to request more information including documentation to show proof of information provided.

Question Title

* 3. Please provide us with the following information about your financial situation:

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* 5. Please help the selection committee understand your need by describing the challenges you face and reasons you are applying for this category.

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* 7. How much are you applying for?

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* 8. Please provide any additional information that you wish the selection committee to know. Do not include names of yourself or family members to ensure your application is anonymous.

* 2. Please provide us with your personal information. All answers must be completed in full.

NOTE: We reserve the right to request more information including documentation to show proof of information provided.