Application for Funding

Applicant Name *

First Name

Last Name

Applicant Phone

(###)

###

####

Applicant Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Name *

Host family, character reference or sponsoring agency. A sponsoring agency is an organization that assists with temporary accommodation and/or provides basic assistance to an individual or family.

First Name

Last Name

Reference Phone

(###)

###

####

Reference Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Has the applicant moved to Canada in the last 18 months? *

Yes

No

Who will this grant support? *

Refugees

Ukrainians fleeing war

Other

If less funding is available than you've requested, can you still proceed? *

Yes

No

Can you provide a receipt? If so please send a copy to newcomerfund@gmail.com *

Yes

No

Would you like to receive additional information about services available for immigrants and newcomers in Huron County?

Yes

No

Today's Date *

MM

DD

YYYY