Emergency Funding Application Form

Please complete the form and send appropriate documentation for the emergency need directly to one of the REACH Co-Chairs. A REACH Co-Chair will acknowledge receipt of the documentation and the form. The REACH Co-Chairs and one additional Executive Committee Member will review the request and respond to it via email within four business days of receipt.

Please provide what type of need you are requesting funding and the amount needed:
(Enter all that apply)

Please send documentation of the need after submitting this completed form to mlause@mercy.com. Documentation could be a copy of a lease, a utility bill, an invoice, a phone bill, or something else. Contact a REACH Co-Chair if you have questions.

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