Grant Application -TEST

Monthly Budget

Once your current hardship is resolved, what will your monthly budget look like? Using one of these templates, please complete and submit your monthly budget.

• Monthly Budget Worksheet (PDF)
• Monthly Budget Spreadsheet (Excel)

To submit your budget you may:

• Upload a copy with your application using the "File Upload" section below; or
• Email it to us separately

I certify that to my knowledge I am in compliance with all laws, statutes and regulations restricting U.S. persons from dealing with any individuals, entities or groups who are subject to economic sanctions imposed by the U.S., such as countries subject to embargoes or groups of individuals, such as terrorists and narcotics traffickers.

I consent to the processing of my personal data contained in this Application for verification purposes and the potential disbursement of a grant from the Jack’s Family Fund. I further consent to the transfer of the contents of this Application to the Fund located in Birmingham, Alabama, USA, the Jack’s Family Fund Administrator, the Jack’s Family Fund Board of Directors or Allocation Committee Members.

I further certify to the Fund that the information contained in this Application is true and correct.

By accepting a gift from the Fund, I agree to provide copies of the following materials if requested by the Foundation: receipts demonstrating the emergency hardship, my expenditure, and documentation illustrating my relationship to the Applicant, if I am submitting this application on behalf of someone else.