Are You Eligible To Apply

Eligibility to Apply for Assistance

The following questions will help determine if you, and your current circumstance, are eligible to apply under our current funding guidelines.

Name*

First Last

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

CAPTCHA

Do you live or work in a community where we operate a Jack's Family Restaurant?*

Jack's Family Restaurant is a regional chain that operates primarily in Alabama (north of I-10). We also have a few restaurants in Mississippi, Tennessee, and Georgia. To find your closest Jack's visit Find a Jack's

Yes
No

We are sorry you are going through a difficult time. However, we only offer assistance to those who live or work in a community where we operate a Jack's Family Restaurant. Therefore, you are not eligible to apply. To find other community resources, please contact your local 2-1-1 service or visit 211.org

Are you seeking a contribution toward your loved one's funeral/burial?*

Yes
No

Is your current need the direct result of one of these hardships:*

accident
crime
death
fire
Currently homeless or in danger of eviction/foreclosure
illness
natural disaster/ storm

Yes
No

Prior to this hardship, were you able to afford all of your essential living expenses?*

Essential living expenses include housing, utilities, groceries, and medical care.

Yes
No

Is your need an expense for which we offer assistance?*

funeral/burial
rent/mortgage
utilities (electric, water, natural gas)
groceries/toiletries
life-saving medical (prescriptions, treatments, procedures)
temporary, emergency shelter

Yes
No

Are you currently (or will you be within the next 30 days) without access to any of the following:*

housing/ shelter
running water
electricity
heat
2 or more nutritious meals per day
basic clothing and personal care items
essential medical treatment/procedure

Yes
No

Screening Tool

Eligibility to Apply for Assistance