The Rapscallion HOPS Foundation Grant Application

Name Of Applicant(Required)

First Last

Applying On Whose Behalf (if applicable)

First Last

Address(Required)

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

Phone(Required)

Email(Required)

Preferred Method of Contact(Required)

Phone

Text

Please describe circumstances that has led to this application for assistance/support.(Required)

Include any relevant details (for example: a recent diagnosis, loss in the family, hhouse fire, medical emergency, or other unexpected hardship(s)).

Type of Assistance/Support Requested:(Required)

Support Information(Required)

Please share a few sentences about how this support would make a difference for you or your family. (This helps us understand the impact of your request.)

Application Agreement(Required)

I certify that the information provided is true and accurate to the best of my knowledge. I understand that completing the application does not guarantee assistance, and all information will be kept confidential and used only for determining eligibility.

I Agree

Signature(Required)

Printed Name(Required)

First Last

Date of Birth(Required)