I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that providing false information may result in denial of assistance and may have legal consequences.
I authorize this organization to verify the information I have provided, including contacting employers, financial institutions, and government agencies as needed to confirm my eligibility.
I understand that assistance is not guaranteed and that the organization will make eligibility and distribution decisions based on available resources, organizational policies, and demonstrated need.
I grant this organization permission to use my case information (with my name removed) for statistical reporting and program evaluation purposes, in accordance with applicable privacy laws.

Your Privacy

This organization takes your privacy seriously. All information you provide will be kept confidential and used only to determine your eligibility for assistance and to comply with legal and financial reporting requirements. We will not share your information with outside parties except as required by law or as necessary to verify the information you've provided.

Documentation and Record-Keeping

This organization is required to maintain records of all assistance provided, including income verification and eligibility documentation, for internal record-keeping and federal tax reporting purposes (Form 990 Schedule I). These records are maintained securely and in accordance with applicable privacy laws.

Eligibility Criteria

To receive assistance through this organization, you must demonstrate:

* Financial need based on household income that meets our established guidelines

* Membership in the charitable class we serve (individuals and families in poverty or facing financial hardship)

* A specific, documented need that our assistance can address

* Willingness to provide truthful information and necessary documentation

Equal Opportunity Statement

This organization provides assistance without regard to race, color, religion, national origin, gender, sexual orientation, disability, age, or any other characteristic protected by law.

This application must be completed in full and submitted with supporting income verification documents when requested. Incomplete applications may be returned to the applicant.

For questions about this application process, please contact Portion & Promise at Portion.Promise@protonmail.com