Grant Application -TEST

Are you completing this application on behalf of someone else?*

Yes
No

Your Name*

First Last

Your Email*

Your Preferred Phone*

Preferred Phone Type*

Do you currently work for JFR or SFM?*

Yes
No

If yes, what is the store number?*

If not, how did you learn about the Jack's Family Fund?*

Please explain in more detail how you learned about us.

If you learned about us from personal referral, who referred you? If you found us through a Google search, what were your search terms? If you learned about us while at a Jack's restaurant, was it an employee who said something or did you see signage of some kind? If you found a link to us on another web page, what web page?

What is your relationship to the applicant?*

If other, please explain.*

Section I: Applicant Information

The applicant is the individual who is experiencing the hardship/ in need of assistance.

Does the applicant currently work for JFR or SFM?*

Yes
No

If yes, what is the store number?*

I understand that information contained within this application may be shared with my/the Applicant's supervisor, General Manager, Area Manager and/or Regional Director.*

Yes

Applicant's Name*

First Last

Applicant's Email*

Applicant's Preferred Phone Number*

Phone Type*

Home Address*

Street Address City State Postal Code

Employment Status*

NOW HIRING - Come join the Jack's family! We are hiring for both management and crew team positions at most restaurant locations. Learn more and apply online at WorkAtJacks.com

Have you applied to work at Jack's?*

Yes
Not yet, but will
No, not interested

What type of work are you looking for?*

Great! What location(s) are you interested in?*

Employer*

Employer Address*

Street Address City State Postal Code

Average number of hours per week*

Salary/Hourly Wage*

How did you learn about the Jack's Family Fund?*

Please explain in more detail how you learned about us.

If you learned about us from personal referral, who referred you? If you found us through a Google search, what were your search terms? If you learned about us while at a Jack's restaurant, was it an employee who said something or did you see signage of some kind? If you found a link to us on another web page, what web page? If you learned about during the hiring/training process, when specifically?

Are you currently enrolled as a student?*

Where are you enrolled as a student?*

How many people live in your household?*

If you live alone, please enter "1"

Please list names and ages of each person in household and explain their relationship to you.*

Example: Myself, 30; Bob, 20, my roommate; Joe, 12, my son; Chris, 8, Roommate's son

Does anyone other than yourself contribute to your household's income?*

For example, do you receive food stamps, child support, or disability benefits? Does your spouse, roommate or child work and help pay the household bills?

Yes
No

If yes, please explain the source if income/support and the monthly amount.*

For example: If you receive $250/month in food stamps and your son contributes $200/month from his paycheck, write "Food Stamps=$250; Son=$200"

Did you receive an economic stimulus payment during in spring 2020?*

Yes
No

Why not?*

Please explain your understanding as to why you did not receive the economic stimulus payment in 2020.

Have you received a federal stimulus check in 2021?*

On Dec. 29, 2020, the IRS began issuing a second round of Economic Impact Payments as part of the Coronavirus Response and Relief Supplemental Appropriations Act of 2021. Direct deposits began on 12/29/20 and paper checks/debit were scheduled to begin distribution on 12/30/20. Have you received this most recent stimulus payment yet?

Yes
No

How much was your stimulus payment and how will/did you spend it?*

Please be as specific as possible. For example, "I received $1200. $400 went toward my electric bill and the remainder went toward my past-due rent."

Step 1 of 4

Section I: Applicant Information

Section II: Request for Financial Assistance

Supporting Documents

Monthly Budget

Every applicant must submit:

Section III: Other Assistance

Section IV: Prior Fund Assistance

Section V: Applicant Certification