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PLEASE BE AWARE OF THE FOLLOWING CHANGES:
HOPEfund grant applications are now reviewed on a
bi-monthly, bill-by-bill basis.
This process will create longer turn around times.
We ask you to plan accordingly.

The HOPEfund

Eligibility and Application Process:

The HOPEsudbury Fund supports Sudbury, MA residents experiencing financial difficulties by providing emergency assistance to help pay for rent, utilities, and other essential bills. We offer grants up to $600 for an individual, $800 for a two or more adult household, or $1,200 for a family (guardian and one or more dependent/s) toward eligible expenses.

To apply for a HOPEsudbury emergency grant, please review the HOPEfund guidelines on our website for more details on the application process and eligibility criteria and then complete and submit the online application below.

The application will be sent to the Sudbury Board of Health Social Work Office, and
someone from their team will reach to you to schedule a brief phone call. Following the call, the Social Work Office will submit your application to the HOPEsudbury board, who will assess your eligibility for the grant. Applications are reviewed bi-monthly

Please review the HOPEfund guidelines for more details on the application process and eligibility criteria. If you have any questions or would like additional support in applying to the HOPEfund, you are welcome to contact the Sudbury Board of Health Social Work Office at any time at socialworker@sudbury.ma.us or 978-440-5476.

Please note: it is not possible to save this form; if you leave this page while completing the application, any information you have already entered will be lost.

HOPEfund application

Name (first and last)

Address (Street, Apartment # if any)

City, State, Zip

Email

Date of Birth (MM/DD/YYYY)

Pronouns

Phone

How long have you lived in Sudbury, MA?

Do you live in subsidized housing?

Yes

No

Do you

Rent

Own

What's making this time difficult for your financially? Please provide as much detail as possible so we can better assist you.

Have you received a HOPEfund grant in the past?

Yes

No

Unsure

If yes, please include the year(s) that a HOPEfund grant was received. If you are unsure, please write unknown

Please note, there is a limit of 5 lifetime HOPEfund grants per household

How did you hear about the HOPEfund?

Are you currently receiving any of the following Non Cash Benefits? (check all that apply)

Housing Subsidy

SNAP Benefits

Property Tax Exemption

WIC

MassHealth

Childcare Voucher

Affordable Connectivity Program/Internet Essentials

Cash Benefits (e.g. TAFDS or EADC)

Clothing Voucher (e.g. Global Thrift)

Food Pantry

Furniture Bank

Meals on Wheels

RAFT

SafeLink Cell Phone

Senior Center

SSI/SSDI

St. Elizabeth's CAREpantry

St. Vincent de Paul

Utility Discounts (incl. fuel assistance and shut-off protection)

Veteran Benefits

Please Note: this question does not impact your eligibility for the HOPEfund; it is used by the social work office to offer tailored resources and referrals to meet your needs.

What type of grant are you applying for?

(refer to HOPEfund guidelines if you are unsure)

Household Information

Are you the sole household income earner?

Yes

No

Are there additional household members?

Yes

No

Second Household Member (include Date of Birth and Relationship to Applicant)

Does this person live with you more than 50% of the time?

yes

no

varies

Is there a third household member?

Yes

No

Third Household Member (include Date of Birth and Relationship to Applicant)

Does this person live with you more than 50% of the time?

yes

no

varies

Is there a fourth household member?

Yes

No

Fourth Household Member (include Date of Birth and Relationship to Applicant)

Does this person live with you more than 50% of the time?

yes

no

varies

Is there a fifth household member?

Yes

No

Fifth Household Member (include Date of Birth, Relationship to Applicant)

Does this person live with you more than 50% of the time?

yes

no

varies

Is there a sixth household member?

Yes

No

Sixth Household Member (include Date of Birth and Relationship to Applicant)

Does this person live with you more than 50% of the time?

yes

no

varies

Are there more than six household members?

Yes

No

List Additional Household Members (include Date of Birth, Relationship to Applicant and Percent of Custody (if applicable)

I acknowledge and understand that there is only one grant per household/address allowed every 12 months; if my application is approved and someone else from the same household tries to apply, they will be informed that they are ineligible because the grant has already been made to their household/address.

BILL INFORMATION

Please provide information about the bills you need assistance with in the fields below.

Please also upload copies of each bill and ensure all images include the following: name of company, name of applicant, account number (if applicable), total amount due, and payment address. If any of this information is missing,
payment may be delayed!

At this time we can only accept JPG or PNG uploads.

Alternatively, you may email copies of the bills to to: hopefund@hopesudbury.org
You may submit 1-4 bills on this application.

Bill #1 Company name and mailing address

Amount you would like HOPEsudbury to pay

Upload File (jpg or png only)

Upload supported file (Max 15MB)

Upload a copy of bill #1 here or email a copy to: hopefund@hopesudbury.org. Please make sure bill includes name of company, name of applicant, account number (if applicable), total amount due, and complete payment address. Payment may delayed if all this information is not clearly indicated!

Bill #2 Company name and mailing address

Amount you would like HOPEsudbury to pay

Upload File (jpg or png only)

Upload supported file (Max 15MB)

Upload a copy of bill #2 here or email a copy to: hopefund@hopesudbury.org. Please make sure bill includes name of company, name of applicant, account number (if applicable), total amount due, and complete payment address. Payment may delayed if all this information is not clearly indicated!

Bill #3 Company name and mailing ddress

Amount you would like HOPEsudbury to pay

Upload File (jpg or png only)

Upload supported file (Max 15MB)

Upload a copy of bill #3 here or email a copy to: hopefund@hopesudbury.org. Please make sure bill includes name of company, name of applicant, account number (if applicable), total amount due, and payment address

Bill #4 Company name and mailing address

Amount you would like HOPEsudbury to pay

Upload File (jpg or png only)

Upload supported file (Max 15MB)

Upload a copy of bill #4 here or email a copy to: hopefund@hopesudbury.org. Please make sure bill includes name of company, name of applicant, account number (if applicable), total amount due, and complete payment address. Payment may delayed if all this information is not clearly indicated!

If you have more than 4 bills to submit at this time, please email: hopefund@hopesudbury.org.

CERTIFICATION AND RELEASE OF INFORMATION

Please be sure you have answered all questions to the best of your ability so that we can process your application quickly and efficiently. If it is determined that your household is eligible, under the program guidelines, payments will be made on your behalf directly to the vendor of the bill(s) you submitted.

By checking and signing below I certify the following:

Certification of application:

I have read, understood, and agree to the HOPEfund Guidelines/FAQ. I understand that my eligibility is dependent on me filling out this application truthfully and to the best of my ability. I promise that the information contained on this application is truthful. If information is found to be untruthful, your household may be ineligible for HOPEsudbury programs. I authorize HOPEsudbury and the Town of Sudbury Social Work Office to verify the information provided.

Release of Information:

I hereby give permission for this application and the information contained within it to be shared with HOPEsudbury Board Members and Town of Sudbury Social Work Office for purposes of approval, payment, and program management. HOPEsudbury shall have no liability related to the release of information.

This application may be executed by electronic signature which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

By checking this box I agree to the terms & conditions

Applicant Signature

Please hit "submit" only once;

it may take a few seconds for you to

receive confirmation!

© 2020 by HOPEsudbury

Email:

info@hopesudbury.org

Tax ID# 55-0796459

Mailing Address:

HOPEsudbury

P.O. Box 802

Sudbury, MA 01776

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