Grant Application Online

START THE APPLICATION HERE:

Your Name*

First Last

Today's Date*

Best way to contact you:*

Email

Phone

Text

Check all that apply.

Email*

Phone*

What kind of phone number are you supplying?*

Land Line

Cell Phone: It's okay to send a text

Cell Phone: Do not text me

Do not call me by phone

Only call me during the following hours:

Birth Date*

Mailing Address*

Street Address City



State ZIP Code

The above mailing address is:*

the mailing address of my permanent residence

the mailing address of my my seasonal residence

I do not own or rent on the North Fork, but I am a member of NFWFWF

Street Address

My local street address is the same as my mailing address

Local Street Address

Street Address City



State ZIP Code

Whether you rent or own, what is the street address of your residence in the township of Southold, Riverhead or Shelter Island.

Notes to NFWFWF

GRANT TYPE REQUESTED

B. What type of Grant are you requesting*

A Grant for health related expenses

A Grant for non-health related expenses

A Grant for a LifeLine Medical Alert only

Lifeline applicants should click 'Next' and proceed directly to Section G.

YOUR INSURANCE INFO

A. Your Current Medical/Dental Coverage:*

I do not have medical or dental coverage

I have Medical Insurance

I have Dental Insurance

Check all that apply.

C. What is the reason for your Grant request?*

Describe your situation; i.e.: medical condition(s) or living condition(s):

FINANCIAL INFORMATION

NFWFWF does not require formal documentation of your income or insurance coverage at this time. However the information you provide is important to us in considering your request.

D-1. What is your total estimated monthly income:*

D-2. What are your total estimated monthly expenses:*

OTHER ASSISTANCE

E. Are you applying elsewhere for assistance?*

Yes, I am applying to other organizations for assistance

No, I am not applying to other organizations for assistance

F. GRANT AMOUNT BEING REQUESTED

Please note that in order to receive a grant you must supply Estimate(s), and/or an Invoices(s) that total to the amount being requested. You can mail copies or scan and upload them using this form. All documentation must be dated within 12 months of receipt of this application.

Total Amount You Are Requesting*

Use numbers only.

Documentation*

I will mail copies of my documentation .

I am uploading my documentation.

I do not have documentation

Mailing address for documentation: North Fork Women, PO Box 804, Greenport, NY 11944

Optional Notes

H. APPLICANT SIGNATURE and ACKNOWLEDGEMENTS

Full Name of Grant Applicant*

Today's Date*

Email

This field is for validation purposes and should be left unchanged.

NFWFWF Grant Application

Please fill out all required fields for the type of grant you are requesting. Have any documents that will help to support your grant application ready to upload when asked, such as estimates or unpaid bills.

The information you give to us is confidential. It is known only to the Treasurer and Administrator. All identifying information that is disbursed to the Grant Committee for review is redacted, including name, addresses, phone and email.

Any questions or concerns should be sent to grants@nfwfwf.org

START THE APPLICATION HERE:

GRANT TYPE REQUESTED

YOUR INSURANCE INFO

FINANCIAL INFORMATION

NFWFWF does not require formal documentation of your income or insurance coverage at this time. However the information you provide is important to us in considering your request.

OTHER ASSISTANCE

F. GRANT AMOUNT BEING REQUESTED

Please note that in order to receive a grant you must supply Estimate(s), and/or an Invoices(s) that total to the amount being requested. You can mail copies or scan and upload them using this form. All documentation must be dated within 12 months of receipt of this application.

G. GIVING BACK

H. APPLICANT SIGNATURE and ACKNOWLEDGEMENTS

NFWFWF Grant Application

Please fill out all required fields for the type of grant you are requesting. Have any documents that will help to support your grant application ready to upload when asked, such as estimates or unpaid bills.

The information you give to us is confidential. It is known only to the Treasurer and Administrator. All identifying information that is disbursed to the Grant Committee for review is redacted, including name, addresses, phone and email.

Any questions or concerns should be sent to grants@nfwfwf.org

START THE APPLICATION HERE:

GRANT TYPE REQUESTED

YOUR INSURANCE INFO

FINANCIAL INFORMATION

NFWFWF does not require formal documentation of your income or insurance coverage at this time. However the information you provide is important to us in considering your request.

OTHER ASSISTANCE

F. GRANT AMOUNT BEING REQUESTED

Please note that in order to receive a grant you must supply Estimate(s), and/or an Invoices(s) that total to the amount being requested. You can mail copies or scan and upload them using this form. All documentation must be dated within 12 months of receipt of this application.

G. GIVING BACK

H. APPLICANT SIGNATURE and ACKNOWLEDGEMENTS