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Home
Who We Are
Our Team
Our Families
Agency Partners
Community Partners & Sponsors
Media Coverage
Our Programs
Back to School Assistance
Kindness Warrior Program
Holiday Assistance
Stabilize Families
Donation & Empowerment Center
How You Can Help
In-Kind Donations
Volunteer
Donate
Contact us
Donate
Holiday Assistance
Gold & Diamond Source Gives Back
Agency Referral Application
Law Enforcement Pick-Up Request
Back to School Assistance
Williams Automotive Group Employee Assistance
Please Fill Out The Form Below:
Full Name
*
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
MM
DD
YYYY
Please upload a copy of your Photo ID
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Louisiana
Maine
Maryland
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Michigan
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Nevada
New Hampshire
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New York
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
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Virginia
Washington
West Virginia
Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Email Address
*
Preferred Method of Contact
*
Phone
Email
Which dealership were/are you working at?
*
Have you been awarded any funds from this program previously?
*
Yes
No
How much have you been previously awarded?
*
Enter USD
What type of assistance are you requesting?
*
Please explain the circumstance surrounding your request for assistance.
What amount of assistance are you requesting?
*
Application Statement: I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate, and complete. I unerstand that the omission and/or misrepresentation of any fact from or on this questionnaire will result in immediate rejection of my application. Unless I noted otherwise, I authorize Hands Across the Bay to contact all of my personal references and do a criminal background check. If assisted, I agree to abide by all rules and regulations of Hands Across the Bay. I understand and agree that nothing in this application shall constitute an offer, a contract, or a guarantee of assistance. I understand that any decision is contingent upon my successful completion of all of the Company's lawful pre-assistance checks, which may include a background check. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-assistance checks. By signing below, I agree to all of the terms stated here.
Signature
*
Date of Application
*
MM
DD
YYYY
Consent
I agree to the privacy policy.
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