Social Services Relief Fund Application

Funding is being provided under the Social Services Relief Fund is to assist municipalities and social service providers such as shelters, food banks, emergency services, community and supportive housing providers, charities and non-profits continue to deliver their critical services.

Please note that funds are limited and as such amounts requested may be approved in whole, in part or not at all.

Applications will be reviewed on a priority basis.

PART A - Organization Information

Organization Name:

Mailing Address:

City:

Postal Code:

Contact Name:

Phone Number:

Email Address:

Service Area:

Number of staff/volunteers in your organization:

PART B - Funding Request

Eligible expenses: direct assistance to clients for food supplies, lodging, communication or transportation; enhanced cleaning services, personal protective supplies for clients or the organization.

Ineligible expenses: any other expenses not listed.

Are you closed to the public?

If yes, are you still serving the public?

Reason for request (we may contact you if more information is required to support your application):

Amount requested:

Have you already requested and/or received additional funding from other sources?

If yes, from where and how much?

PART C - FUNDING AGREEMENT

If you are approved for funding, you will be required to sign a funding agreement with the City of Cornwall.

PART D - SIGNATURE

This application must be signed by a recognized signing authority within your organization.

Name of Authorized Representative:

Date:

Signature of Authorized Representative (use your mouse to draw your signature):

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Social Services Relief Fund Application