CoronaVirus Emergency Fund

To help in these difficult times, we encourage members to review the services available to Pennsylvania residents or to South Jersey residents. After that, please complete the following form and we will contact you as needed.

Name

Region

North Region UC United Havertown South Jersey Unknown

This address will receive a confirmation email

Address

Phone

Reason for Request - Your COVID-19 circumstances and explanation of the impact on your finances (attach support if available).

Supporting Documentation

Upload (8MB)

What to Pay (Limit $1000 per member)

On each line, list each Payee, Payee address, the amount, and the Purpose (utilities, groceries)

Delivery Instructions

Process for Delivering the Check(s) to Vendor(s)

Printed Signature of Applicant

Description

Please fill out this form and click submit.

CoronaVirus Emergency Fund

Description

Please Fix the Following