RELIEF FUND — Jupiter Foundation

HOSPITALITY RELIEF FUND

FINANCIAL ASSISTANCE GRANT APPLICATION

Please read through the Selection Criteria and Eligibility Requirements for the “Hospitality Relief Fund” if you believe that you are eligible, please fill out the application making sure to include the required supporting documents.

ELIGIBILITY REQUIREMENTS

In order to qualify for grant assistance from the Hospitality Relief Fund, the recipient must satisfy all of the following requirements:

Be a Bartender/Server or the spouse or child of a Bartender/Server. The Hospitality Relief Fund defines a “Bartender/Server” as an individual employed in serving beverages or otherwise engaged in the production, promotion or distribution of alcoholic beverages. An individual is considered “employed” as a Bartender/Server if, for not less than one year prior to the application, the individual performed services as a Bartender/Server on a regular full- or part-time basis or, if the catastrophic event or emergency hardship giving rise to the application prevents the individual from performing such services, for not less than one year prior to the event or hardship the individual performed services as a Bartender/Server on a regular full- or part-time basis.

2. Experience a catastrophic event or emergency hardship that is:

Identifiable and described in detail in the application;
Damaging to the person or property (e.g., loss of life, health, or property);
Sudden and precipitous rather than gradual or progressive;
Unexpected, unanticipated, unforeseen, unintended, or unplanned; and
Unusual and not normally occurring in the ordinary course of day-to-day living.

3. Lack the necessities of life, including financial, physical, mental, or emotional well being as a result of the catastrophic event or emergency hardship.

4. Provide tangible documentation of the catastrophic event or emergency hardship.

SELECTION CRITERIA

Grant recipients will be selected solely on the basis of the eligibility requirements above. Each grant applicant will be pre-screened for compliance with the eligibility and application requirements on an objective and nondiscriminatory basis by the Jupiter Foundation or other persons designated by Jupiter Foundation. All pre-screened and approved applications will be submitted to Jupiter Foundation members for review. Grants will be awarded by Jupiter Foundation on an objective and nondiscriminatory basis upon reviewing the application and ascertaining any additional facts and circumstances as necessary.

Grant applications will not be denied solely due to the fact that the Bartender/Server terminated employment after the application was made, regardless of the reason for such termination. Moreover, at the time the grant is awarded, there will be no requirement or condition, express or implied, that the recipient render future employment services as a Bartender/Server.

Grants will be made in the form of lump sum distributions to the recipient, or as determined by the Jupiter Foundation based on the needs of the particular recipient. Each grant recipient will be required to provide Jupiter Foundation with documentation that the grant was used in a manner consistent with the terms of the grant. Although the extent and form of documentation required in connection with a particular distribution will depend on the nature and urgency of the underlying catastrophic event or emergency hardship, preferred documentation will include evidence produced by third parties and used for other purposes, such as police reports, fire department reports, medical prescriptions, receipts, eviction notices, condemnation notices, overdue invoices, other third party affirmations and other similar tangible documentation.

Please read through the Selection Criteria and Eligibility Requirements for the Bartender/Server Hospitality Relief Fund Program and if you believe that you are eligible, please fill out the application making sure to include the required supporting documents.

Relief Fund Form

Applicant Information

Please make sure you have read through the Selection Criteria and Eligibility Requirements on the website for the Hospitality Relief Fund, and if you believe that you are eligible, please fill out the application below, making sure to include the required supporting documents.

Select

Who is filling out this application? (please choose one)*

Date

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Applicant Employment History

Annual Household Income

Please provide your Annual Household Income for the most recent tax year.

Employment History (last 12 months)

Description of Hardship

Amount of Financial Assistance Requested

Grant Recipient Information

Recipient is (please choose one)

Name

First Name

Last Name

Social Security Number

I hereby authorize the Jupiter Foundation to investigate my background and qualifications for purposes of evaluating whether I am qualified for the grant for which I am applying. I understand that the Jupiter Foundation may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the organization's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for a grant will not be processed further.

I Agree

I Disagree

I certify that all information is valid and complete and hereby authorize the Jupiter Foundation to verify any of the above information as deemed necessary. I confirm that I have reviewed the Hospitality Relief Fund Eligibility Requirements and Selection Criteria and that, to the best of my knowledge, the above-mentioned recipient is eligible to receive a grant from The Jupiter Foundation. I understand that in the event the Jupiter Foundation awards a grant to the above-mentioned recipient, I may be required to provide subsequent documentation regarding the use of the grant funds.

Yes