arrowheadunitedway.oneeach.org

Assistance Request Form

Arrowhead United Way Has Established an Emergency Relief Fund to Support those in the Arrowhead United Way Service Area Who are Most Vulnerable during the COVID-19 crisis. This fund will help support: low-income individuals and families at imminent risk of homelessness; the current IE population experiencing homelessness; low-income students; and our partner non-profits.

Funding for a ONE-TIME financial assistance will be available BASED ON CONTRIBUTIONS RECEIVED. United Way is not able to guarantee funding beyond what is received in this fundraising effort.

To make a donation to the San Bernardino United COVID-19 Relief Fund, please click here.

To request a ONE TIME payment assistance, please fill out the form below.

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First Name *

Last Name *

Address *

City *

Zip code *

Phone *

Email *

Age of applicant *

18-30

31-54

55-70

71+

Please describe *

Select all that apply

Veteran

SSI Reciepent

SNAP Reciepient

Number of people in the household? *

Anyone in the household under the age of 18? *

Yes

How many under the age of 18? *

Tell us your story *

Please describe how the COVID-19 pandemic has affected you. Feel free to share whatever you think will be important for us to know about your situation. If you need more space, please attach your story below

Attachments

Please feel free to attach your story here
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

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Assistance Request Form