Grocery Worker's Relief Fund Application

The following questions are required and will be used to verify eligibility for the Grocery Worker's Appreciation Fund, to contact you if we have any follow-up questions, and to notify you if you are selected to receive financial assistance or specify exactly what is being awarded.

Are you currently employed by a grocery store or a store with a grocery department? (Disclaimer: Instacart, DoorDash and Uber Eats employees do not qualify at this time)

The Grocery Worker's Appreciation Fund is only available to current grocery store employees at this time.
If you still need help, please call 211 or visit 211.org.

Are you at least 18 years of age or older?

You must be 18 years or older to apply for the Grocery Worker's Appreciation Fund.
If you still need help, please call 211 or visit 211.org.

What is your year of birth?

Legal First Name

Legal Last Name

Daytime Phone Number (XXX-XXX-XXXX)

Email

Please provide your direct email address.

Postal | Zip Code

How would you prefer to receive information about your eligibility and/or award?

Please provide your mobile number (XXX-XXX-XXXX)

Contact Account Record ID

Where Raised LUW ID

Please tell us why you are applying for financial assistance.

What is the total income your household expects to earn in 2020?

Are you or someone in your household experiencing financial challenges?

Have you or someone in your household been furloughed, laid off, or fired due to the COVID-19 pandemic?

How do you intend to use this financial assistance? Select up to 3 (SHIFT or CMD key)

Other intent for financial assistance:

Please provide any additional comments or information about your household and need for financial assistance:

Below are examples of a blocked-out paystub.

Please block out all information except your name, the pay period and/or pay date of the paystub, and the name of your employer.

Please do not e-mail your paystub or upload any other items like bank statements, direct deposit slips, identification, or other images as your application will be automatically disqualified.

Please select the name of your company/employer. This will not be shared with your employer.

If you selected other, please input the name of your employer

Please upload your most recent paystub from your employer to verify employment. Please block out all information except your name, the date of the paystub, and the name of your employer:

Image files only (BMP, JPG, JPEG, PNG, etc.)

The following questions are for demographic purposes only and will not be used to determine eligibility for the fund.

Gender Identity

How many dependent children under the age of 18 currently live in your household? (Enter "0" if none)

Are you a caregiver for an older adult or person with disabilities?

By selecting "Yes", you are certifying that everything within this application is true and accurate to the best of your knowledge.

Yes

By selecting "Yes", you agree that United Way Worldwide and its subcontractors may contact you in connection with your application.

Yes

I want to receive other email communication from United Way Worldwide about programs, opportunities, etc.

By clicking SUBMIT, you agree and consent that all information provided on this form, including any and all personal and financial data is accurate and may be used by United Way Worldwide to evaluate your application for the Grocery Worker's Appreciation Fund and all such data may be shared with United Way Worldwide members, affiliates and partners. This data will be securely retained indefinitely. To learn more about how United Way Worldwide uses and protects your data, please see the United Way Worldwide Privacy Policy.

Our Focus

GROCERY WORKER'S APPRECIATION FUND APPLICATION