Ready to apply? Great!

 

This application is divided into the following 4 sections:

1. Parent/Guardian Information

2. Child and Program Information (Children must be between the ages of 5 and 15)

3. Employer and Salary Information

4. Electronic Submission of Required Supporting Documentation

 

Be sure to consult our Application Guidelines to check eligibility for EAM assistance.

Please note: This form can support applications for up to three children and three programs. If you wish to apply for more than three children and/or programs, please submit an additional application. You will not need to resubmit duplicate documentation. We apologize for any inconvenience.

 
Parent/Guardian Information
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Child and Program Information
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Do you have another program and/or child you are seeking assistance for?

Reminder: This form can support applications for up to three children and three programs. If you wish to apply for more than three children and/or programs, please submit an additional application. You will not need to resubmit duplicate documentation. We apologize for any inconvenience.

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Do you have another program and/or child you are seeking assistance for?

Reminder: This form can support applications for up to three children and three programs. If you wish to apply for more than three children and/or programs, please submit an additional application. You will not need to resubmit duplicate documentation. We apologize for any inconvenience.

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How many children under the age of 15 are in your household?
Employer and Salary Information
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Does your employer have a matching gift program?
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Required Supporting Documentation

The electronic submission of all documentation listed is REQUIRED. If anything is missing, your application will be rejected.

  1. Copy of Original birth certificates for all children for whom you are requesting assistance. If you have applied for a grant for a child previously, we still require that you send an e-copy for our files. We apologize for any inconvenience.

  2. Original and most recent pay stub, showing at least 20 hours of work per week (direct deposit pay stubs are acceptable)

  3. A short statement indicating you are a single working parent. Please also briefly tell us about your family and need for assistance.

1. Upload Birth Certificate(s)
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2. Upload Most Recent Paystub
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Thank you for applying!