COVID-19 [Personal] Relief Fund Application

COVID-19 JOINT RESPONSE GRANTS

River Cities United Way, Lake Havasu City, Lake Havasu Area Chamber of Commerce, Havasu Community Health Foundation, and the Better Business Bureau are leading a countywide collaborative to provide assistance to individuals and families affected by the COVID-19 pandemic.

FUNDING PRIORITIES

Individual Financial Need/Health & Food: Individual financial need to help struggling community members secure and maintain basic needs, cover unexpected child care and education expenses, and recover from loss of wages due to closures and social distancing measures.

ELIGIBILITY

Individuals: River Cities United Way will be providing grants to individuals disproportionately impacted by the Corona Virus and the economic consequences of the pandemic.

The COVID-19 Joint Response Effort was established to assist our most vulnerable community members. Please keep in mind we expect a high volume of applications. Applications will be processed on a rolling basis for as long as funding is available.

Once completed, your application will be sent to a community board of volunteers for case management services. A representative from this group will contact you to review your application.

First Name *

Last Name *

Home Street Address *

City + State + ZIP *

Phone Number *

How many people live in your home: Adults (including yourself) *

How many people live in your home: Children Under 18 *

Type of help needed & Verification Information

IF RENT / MORTGAGE: Please provide the name of your Landlord/Rental Company, their name, address, phone number, and the amount due.

IF UTILITIES: Please provide the name of your utility company, name the service is under, account number, and amount due.

Were you working in Mohave County at the time of your job loss or wage reduction? *

If Yes - Name of Employer

Date of job loss or wage reduction *

Hourly Wage Prior to March 1, 2020

Do you have a job you will be returning to?

No
Yes, current employer
Yes, new employer

By checking this box, I certify the accuracy of the information provided in this application and formally request assistance. In addition, I give permission for River Cities United Way to share my information with applicable funding sources, utility providers, and landlords/mortgage companies for the purpose of processing my application and preventing duplication of service. *

I Agree

Submitting an application does not guarantee assistance. A phone/email interview will be conducted in further consideration of assistance. River Cities United Way and it's partners will assist to the best of their abilities. *

I Understand