Emergency Financial Assistance
( % !( (#
(
#
( #
( ( (# ( " #(
(&
#
(' # (
(
( % # (
( ( ( #( (
$ #
$( (
( ( &
#
( # #% (
r ˩ 7ț0
˩ ů˩ƛ˩ ˩¾Lj
ǐv˩ Ʌ˩ ˩!˄˕ ˩ Ƙ ˩ ˩ DZ ˩ų_+_˩Ķ ˩i ! ˩ ˩ ť ˩o ¡ ˩ ˩ũ ˩
j ˩
˩! ' ˩
˩ ˩DZ Á ˩! '
˩ ˩ ˩Đe`˩
( ˩ ˩ ! ˣ ˩
(˩ ˔
¡ }_˩Q ˩ ˩ ǡ (˩ Ƙ ɷ˩ ˩,˩ɵ ( "˩ž ˩ ˩ ˩ ǑŹ ˩! ˩ CF ˩iR ˩'X ɲý˩ɢ˩ yȂ˩
u''#ǹǎ^ȎǴIJ`˩˘ˤ Ⱥ
LƅG˩ǝƏȹ#ˉ˩S ij
Àʑʙ˩Ǜ˙ȫ˩ Sį˩x˩°ǃ˩1ɘəŮäǯɣ
˩'
˚ɐ˩U˩\GG ³ĕ`˩§ʥøƠy˩ -¸˩LT~ ˩
ÁÖʞDŽ ATÂ˩ȥ/DZǽ#
˩U˩Rǔ˩ȿ˩\Òđ˝˩Åʋ ˩x˩
ƻɊ
˩DĐe¹˩õ˩˩ʾiɧ -ɎʏsL ˜
ɇ˩ʒX ˩Ⱦ˩ǩǵ Ƕʖʔʤ˩ U˩ʼnʠɚ - Ä˩R ˩Ɠˊ˩ɦ1Õʀ˩
ɰ
˩?
ŲǮDž˩ 7Ǫ0 ʩÆ wɀ˩ ʗ ˩C ˩ ˩NNJ" 5˩
˩ ˩ K ˩p
Ǽ ˩ ˩ĶʆǾˍɗɁƆ˩
rK ˩ ƍʂƵ JǷ7˩ţʓ˩8 B˩ Mˋ˩ƶ ˩
˩6ɛ˩ Ǝ 5
˩ ʡ˩V ˩,785 ., ąˀ ˩nj vɉ ˩
gˆɯOƂ˥Ǔ˩gȜǺǢ CNǀ˩ ˩! O EdžtȈO˩ ˩ɨtˌȳ ɂĦ˩
Z˩ Ŋ ať ƞME˩Ü Ƀ" ǣ ˩ʅNj ˩ ƃ 6Ƥ _˩8 ɜ6 ˩ʯV Ȅ
ŷ ǻƥ ˩ ɫº˩ ȝȞ :˩ Ɉʕ ɿ 6ư:
Z˩ ;J ƾBǁ˩ E »0 ç
Z˩ > 05˩Ý ƨ,ʰQ Ôĩ˩ ˑ Ǥ Ɩ Ú˩ ɸ" Ʉ. (˩ ʎ è˩
.
ŪhŃhŬ˩Żŏé˩ʧķȏÞ¶ǟŁkĸŋżkŭ˩źľŰß=<˩ Ȑ˩ű˩ĂȤ^=dŝ=ê˩ȑȒ½Š Ư˩ĺŜĨŌ˩c ) ˩ăP˩ȉʱ ˅ÇɹɳƇȪ Ȁ˩ɪÈØȁơ˩%H˩ ? D ˩Ŧö˩Ũ ë˩*)*àc ěì˩
ũ˩+ ƌ )ĘĢ[˩˒˩śdȓµ Ǖ˩ ¨-#Û~uȔȱ˞˟Ĝl¼˩ȡ÷4lȧ ȅˎ˩ǞɞɺƫƱĄ ˩Ɛǫ:˩ĝ˩<9˩ ȕ ǥƳʌ$˩+ȬȊƦ{ȟ ˩Ǡʦħę˦˩ō˩Ȗʢ˩āY˩Ȧœ ˩ſȇıá ĞĹ[˩
ėþ˩3 Ǧ ˏ˩˧®«¬˖˩&˩/ȋʺ˩ ˩Ě˩ɮʚ İð˩ŕ˩Hˠ<¯˩&˩IɻŖʼȭP ˩Ĭ#ˡ3 ˩ǖ&˩'şȴ ˩&˩ƈɴ Éŗ ˩ğĤ9˩ŧŽ˩ȗ ǧ$Y˩ ʽƪ ˩ʸÊí˩&˩
ƮÿË˩ĒĈ˩Ɯ˩PʇǿƼ˩˩×ƧĖ˩ ǜŞ$ʛ˩Ɍ/ƺ˩ɟɋ˄ | Ùɔ˩ ʶLJȃ ˩ Ìʲ˩Ǘ¢Ɲ˩ ɼɽ˨őɕ˩ƷAǸ ˩ 4˩Ó˩ 4Řz˩aĉ˩ 2˩ų ©Ƹ˩+ʳ|]j%ÍƬT˔
ȶW˩ǘ%ɾª˩/ʈȆ˩ɬɒ$ ː˩ I˩b˩ȘǍÎ˩ ʨ ˩q˩ġÏċ ¢ɏ˩b˩Œĭł˩ʪ ˩q*˩ Čˢ˩òü˩ƉʫȌȨɠ˩zY˩W2˩ɍƿʍ ˩ĿǬ4˩ ˩?ȵ W3Ʃ˩ș ȢA 3ɤ˩ļȍƊâñʬ
Ʋʣ˩Ļ ˩%H˩*ĥ Ġ˩ĵe˩Ť²î+ŀ˩ Țãŵ ˩ ɓ Ǐ ˩ūƙǭ{˩Őƀ˩ Ċå) 9 ˩ɩ$ʷù˩ř˩ēÐȸ]˩ ǰlj˩ĀŸ Ǚ˩ƽ óú˩ Ƣô˩Ñ˩Ɓȯƣ1˩ 2˩j Ĵʁ ƭɑ˩´ȠīûŴʴ˗˩
ƟĪʹ˩%ǚ˩ 2˩Ƒ˩Ŏ˩ I˩ Dz˩ɭʉ ˩
7× Y°°dY¦»× _e× ¢ÊnK=Ò× ¶8eÌin× ¦× Y× fY¿ aÐ l¿× bP6 ×
I`ÀÓ|× ^×4°kÁ¦×pm×¥×|Å ÆÁee×°YÑyÂצ·×¸ÈÕ ×
Emergency Financial Assistance
c\> K´c-$q`>mx´Q qN".` ´ "=`k;´) m/ ´
**`7 ´
%>ox ´ dl l/ ´
|G ´
]<WQ. ´ NW"?K5$.KK´];WS. ´
!
! ! ! ! Hv×ZC
¨¡
±0×
Hv×ZÃ
¨¡
±1×
DZs0×QQVRRQRRRRRRRQRRRRQRRS× × Hv×ZC
¨A!
±0×
DZt1× TVVUVVUVUUTVUTTVUUTUVW× × HvZÃ
¨¡
±2×
DZt0Q× QVRRVRXRQQRRQQRRRRXRS× × Hv×ZC
¨¡
±0×
DZu2× TTUVVTVVVTTTVTTVVTTVVW× × Hv×ZÃ
¨¡
±1×
DZt0
DZt1× TTVVVTVVVTTTVTTVVTTVVS× ×
$>k{ ´ dl m/ ´ }G ´
]<WQ. ´
c\= K´c-$q`>ox´Q
´
B´e0as0+´R´Xa´ O´^a4h6pC ´y´e0as@T:´A´ nE@0 ´
e´ X8n>>1´+ n1 X8n@@L³ ^^M>& n@XR´y´&raa0Un´j n´ eAe ´
A´e1as0+´Xs0ae0 e´@V ´ ' I ²¯ ´° ´
v©H´v«´=D´ v©H´v«´>>´EhÉ["©&'× ×$/#+
++××:Ƕ¦³ ×@ ² × v¦
´v
«´==´FCª('× ×%.*+ ס´#¡ ´
B¬ºw[×´.-, # × B¬ºx× ×$.++ G¶j ) t¬¥´ 9 ºÄ×f¬¨£ ´ § ¤ J[ §´ !¢®
¤´ B«
Y±ª´
z´_2bEX,´W9´g3auF(2´w i´ 9aZP´~~~~´ n X ´~ ´´O {Ô
Emergency Financial Assistance
RE(Jl ESfl'.\t; \SSIS"I .\'.\l'L \\ ffll
Pfr1.1se J.-s, ribe 1l1e upe11se.1· :,wt nu,:/ <1.v.,-immct 1uth /J.e. RN1J. mifllus. 1,iuliruJ eJ.pmses. p0<I. 1 er�·d.-. ere.)
Expense Amoum E.xpcllY: Amoullt
$$
s$ $ Amount requestoo
$
$
$ $ ---------
$$
R l·�\SO'.\ FOR Fl'.\\'.\('L\I. II\RllSIIIP
Pieuse des, nbe whm ht1/Jpt11«f 1ha1 has eretu,,d 1h;,fimmwrl llil'lli.1hip. A1mch adli1ao,1aJ{l,,..,11111t1t1.• a.v mv:n.1111).
\\II\ I I II\\ I. IH1'.\I. ICl l{l.",OI.\ I. 1111. II\Rl>SIIll'
Plet1se n:pf11i11 hh<1111mu11 fs) _\wt ftaie 1<1kt11 lu u.,ul1e this frarJsltip u11 )uJtru1,11, u1hu lfw11 <1ppl,1ilrgfur<1ssi.,1mrce.
01111.R \(,l.'.\l IL", I \\I \\ORh.l'.\1, \\ 1111 IO Rl.\01.\ 1.11\l{ll\1111'
wPlru.,e l,.,r ulh,·r ttgem i'e., .wu <I.I'<' i,·11,kurg i,uh wrd /,.,... rlle.1 l,m e hd/N'<I /R,.,,J Cru.,.,, S,tlwlimt A.1111\. , <tl C!m1d1, Fm,./ &m/... ,01, J
AJ:l!DC)' Pomt of Contact ]'bone Number "'ith Area Code
P.J�C l
5.<3#<2< / 3<4 0 < '6 "40<: < ;< ;<)*# 00 " < $ <;$6+< ))
4 $" <
«Ɉ¬ˣɄˣǼǿǜʇĩȣˣÁ˒Ȕʔ ŏ"ˣÐ ɰǝȮ ˣ7 üï ƌǎ ˣŧ ? &ʃ77íĮĕİˣ ɴʱ$ˣ]ƾˣʶ(°Ǔ)ʛ°ˣ ˣźÂ#_ &Ǻ˖ˣ& ˣ
$ ˣ Õ` ȩ _$ˣ %ˣ8Åőţ J !ˣ DŽˣ ˣʜƔ˗ʝˣ !ˣ Aˣƪȓ ˣ ˣ ! ˣ ˣ ŒˣÄŖ ŻÒAÆˣ ˣ ƕ Ǟ8Aˣ ŵÇˣ ÑŪŶ˔ Ļq Zˣ
Ǚɭˣs &8X `dˣkǭ ] &˘ˣ˙?+ˣ ˣ` ȋ!oˣŠ ˣ0 ʷĎ+ˣ µ Ǵˣ# ǢƖ vˣ
«ȴȵ¬ˣȶǵˣłɟǟˉȱȕżˣŨ˚Ʊȧʲä ˣ8rŽ ˣ ˣ 2<ˊ)¤ ˣ 7% 8Ì &ÈĤˣŞ ļé ʅˣ "ˣ ɱˋ1Ȗ ˣ ŗ7ˣ_çƇ& ˣ ɠ¿"ˣ &#ˣɃˣ dˣ ˣœ $ˣ ʒÔrˣ ɼ ˣ
ˣʞ ˣs ˣ³ ˣ ˣȝȷ ˣ ŷX ³ % ȿ l$ýˣ ˣĽå ?+ˣ ˣˇȸ "ˣ®ɯīĥ$ˣɡƭq l$ˣ 0 "+ˣ ʳ ˣ ƗĄʽ ȫˣ #ˣɽoJ £ ˣĢǗȹµ ȞǑˣ
º ɲˌ)¤ »ˣƉˣ+ ʻî ɢȗĴˣ ˣɮƣ ®ʦ ˣ
(9<%,<ƐǶǷɾˣ,%-<ʸǣƘˣ &7< - <ɻŰñǽȬˣ
1 8! < Ņ ˣ Ƒˣ Öwˣ ˣȯ ˣʩʓƙˣ ˣžƽľ×Ė ˣ %É#ˣȥȘ˛ˣ˜ %ˣ ˣAņ ː
" !ˣ %ˣ dǒĂǧ0ˣĦô# ˣ Džˣ ˣËŇ$ ȢȉÓ ˣJˁ lˣ ƒ % ˣƎˣĆêāƻˣ ˣ #ˣ ˣƚ" ŀˣ "Î#ˣȦ 3ˣ% ɪȟ ǹȂë ˣ dž "ȇƂdzˣ õˣ 0ˣ
ʼk ˣ öˣ ˣ ħwˣ ʴ ˣ ˣǪʈ ! ˣ± ˣ ƴ÷¾˝ˣ J!ˣįđˣĿ+#ˣ ɫȺ ˣ ˣ ˣ ??0 ăǨ ˣģ ]kɳĨ ˣ
'
' 'Ȍ˂ˣ
' $ ' ' # ' '! ' ' ' %&"
ǸfpS ˣċɓ
L
>Rˣ Őˎ9 þɂˣ@ ĬɐʉˣŜ
ˣ f
ǚˣ¸ʟnɛ N ɀʬ ʤȠ Rˣ ǁǂ
ˣøǬ Í ˣWSɣˣƋɔ
ǮK
ˣŸǠ
iˣŘˣȀCƵ ˣĭʊǰ ˣ˃Sˣ
ªɶʵ ˣ
ˣ'=ˣ¡ˣɌˣ¼ÊTǩ ƩˣȻȼ
ǤLx =zğˣØė ʗĠġɤˣ@/Cˣ cˣɉ'ˣǛYòˣ
ˣ
ŤȨ ˣ /ƅYƶˣ Y ˣW=V ˣƫP iǃ ˣ¨
ǫĉ
z{ˣ@
/ˣķi ˣ eʪ
ˣ¯ʠ ɚ ² NˣƳVȑ oƏ Rˣ ˣ¦ɝʼnșű
ǔè9ˣ : Ȱňˣ pSˣĘ[ˣ
ʄáˣ
hˣĵɗßƟ: ; Ƭˣ LJˣʘ9ˣƷɹˣùȅƨ>ɥˣ² ˣ eʨąÙ
ˣřƮ
Ʌ ˣ LjɍȚǻ > ˣ Ů à a ' ˣc˞ˣ P ˍXˣ TȆſ
ˣ ˣ ˣ ;ˣ ˄ɑɦˣ¨ ˑ
L
Zˣ
ĒěyƠƼˣęǕʋˣƆˣ ãƀĜĝˣʌˣ ɿúˣ ū>ˣ/
ˣ ʿɘ ' ˣ/ ʀˣnɵ:æ
˟Ú3ˣ ˣƦʆˣ VȐ ŚʐɬmRˣ½ˣ ȡǘˣƍbˣ eʫ
Zˣ Ō¥ ʾˣ ' ˣ
cÀˣ@
ˣ WˣȁĹˣ˅©ʧTˣĺ
L
m ˣ Ŋƥ ˠ ɇˣĸƓʡ'ˣ aÛǡĊˣ ¦ˣ^ƈ ˣ[y{ˣ
ˣ Ƚ Ȏ ˣ ·ì¥
K^
9ˣ' ˣ¡ ˣ Ŵɒˣɋ ˣ ; ɺƄ ˣ
Ɋˆˣ Ư
=§ ˣ ȾÏȏ ʖˣ 9ć
:ˣ ' ˣWȲʮˣƸďˣ ˡˣ ˏb Ěˣ ˣ
hPvˣ
ń bˣ¢ƃ 0ƿˣx[ˣ
hˣ ưƤˢˣ ʂƧˣ CðĪˣś a = ˣ Ŕ;ˣpȳʯˣ Ȋ
NˣĈ Tơʁ3ˣəȪˣɎˣ ȍ
ˣƛɆʍ ˣ lj Ȓ
Ǿ ˣǀN ÜˣŹ/ ˣ@ ˣKȤˣɞÝÞ Ǐˣˈ©ʭˣ ª :ŝ > 3ˣ ȹˣ ¢ȈƢ Cˣ ;m PˣVâ ˣ ŋƹ ¯ǯȄˣ fKˣ n ·˓Ɓ
ˣč ˣƲ ˣ ȃˣnjǥ§
ˣƊ ˣ
ȭʎˣÿʢĀˣ ^DZƺʥˣĞĔˣ
ɕɖ Ɯ !ˣÃˣĶ ɜ" ǐˣ Ɂ £!± !ˣ +ˣˣ ûˣ ʺʑ 3ˣɏˣ Dzʙˣ ˣ ʰˣ ǍǦʕó ˣ
\ ʹ ɧ ˣFˣŬʣʚO ˣ
*ˣ ųˣōO(gǖ*ˣ I ț* ɨˣ
ş)Ɲ ʏ ˣ(Ȝˣ . DŽDŽ & ˣ ũ g<1Q Oˣ (ɷ1ɸˣB. Dˣ 2 UUˣ -HGGˣ\ˣ
´( *<1Qˣ ¶tˣ. DŽDŽ & uˣ ˣ 665~ˣ
B Dˣ-, E,}54
j <O˕ˣ
*ˀI Q* 2Łgj (
Fƞ1jˣ