REQUEST HELP – Individual or Family Application

Recipient Information

Recipient name*

First Last

Aliases

i.e. maiden name, etc.

Pronouns

Birthdate*

Address*

Street Address Mailing address if different from street address (use N/A if needed) City State / Province / Region ZIP / Postal Code Country

Phone

Email*

Social Media

We use this information solely for vetting the application.

Do you have a Facebook account?*

Yes
No

Facebook URL

Do you have an Instagram account?*

Yes
No

Handle for Instagram

Do you have a Twitter account?*

Yes
No

Handle for Twitter

Do you have a LinkedIn account?*

Yes
No

LinkedIn URL

Links to other social media

YouTube, TikTok, Snapchat, etc.

Applicant Information

This section can be skipped if the Recipient is same as the Applicant.

Relationship to the Recipient

Applicant Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

URL to personal social media accounts

ie. Facebook, Instagram, Twitter, LinkedIn If you don't have any social media, please type "I don't have social media."

Tell Us About the Situation

Please provide a detailed description of the situation.*

A long story is not necessary, but details are helpful -- i.e. employer’s name, specific diagnoses, dates, links to articles, etc.

Children's Full Name and Ages (if any)

Please write a short paragraph explaining a proposed way for Together Rising to help. Please be as specific as possible, and list concrete things that would be of assistance to you.*

Together Rising provides grants of funds or goods only. We are unable to provide advice, provide connections with service providers, or promote fundraisers, products, or businesses.

Documentation is critical to our review process. Please provide documentation that supports your story and request. For example, if you are requesting support for medical needs, documentation may include proof of diagnosis, relevant bills, and/or a link to the requested item. Please also upload any pictures of you and your family that you're willing to share.

Drop files here or

Max. file size: 64 MB.

File size cannot exceed 2MB.

Please include contact information for third party persons familiar with the situation.

Names and contact information for other organizations you have contacted to seek help for yourself or the applicant, whether currently or in the past. Please identify any online fundraisers (including links to such fundraisers), government grants/assistance, prior grants from Together Rising, and/or other sources of assistance you have received to help with this need. (Please note that, having received other forms of assistance does not preclude you from receiving assistance from Together Rising. This information is used merely as part of our diligence process.)*

If this grant is funded, Together Rising loves to share our giving stories with our community. Given sensitivities, we will often change names and limit details. Please select below if you do not want us to use pictures and your correspondence in sharing these stories. Please also check below if you would like us to anonymize your first name. We never use last names.

Please do not use any portion of our correspondence (quotes from the application or emails, etc.).
Please do not use any pictures I provided with this application.
Please anonymize our names.

How did you hear about Together Rising?

REQUEST HELP – Individual or Family Application

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Individual or Family Application

Recipient Information

Social Media

Applicant Information

Tell Us About the Situation

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