The Ark of Refuge CA Care Grant Application

The Ark of Refuge (www.TheArkofRefuge.Org) is distributing CA Care Grants to Sponsor Recommended Recipients beginning March 1st, 2021 - April 22nd, 2021. If you have received this link an Ark of Refuge member has recommended you for sponsorship. The grant amount is $225.00 payable upon completion of the application.

The Ark of Refuge is a 501(c)(3) nonprofit which focuses on relief for transient communities specifically targeting (TAY) Transitional Aged Youth in the Greater Bay Area. For the year 2020 , Thanksgiving distributions totaled over $5,000.00. We were able to successfully distribute 120 meals to encampments. For Christmas, The Ark of Refuge provided gifts and cooked an eight-course meal for three families consisting of five children each.

The everyday power struggles between law enforcement entities and the hidden population of independent teens,otherwise known as TAY, breed youth to be distrustful of programs provided by the government.The ARK of Refuge Leaves No Person Uncounted by indirectly re-building that trust through providing services funded by governmental grants and private donations.

Eligibility Questions

Are you an United States citizen? *

Yes

No

Do you have a Valid Drivers License? *

Yes

No

Do you have any Visual Impairments? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

If yes, explain. *

In the past 30 days have you been at risk of homelessness? *

Yes

No

Are you an Emancipated minor or a Foster youth in - custody? *

Yes

No

Will your food expire or deplete before the end of the month? *

Yes

No

Are you a runaway or at - risk youth currently living on the streets? *

Yes

No

Have you experienced mental, physical, emotional, or financial abuse in the past 60 days? *

Yes

No

Are you seeking employment? You must be seeking employment in order to be eligible for the care grant. *

Yes

No

Which sponsor would you like to hear from regarding a possible employment opportunity? *

ChickPick Delivery Services	The Ark of Refuge 501c3 Non Profit
Writers Corner Integrated Marketing Firm

Have you ever been diagnosed with a disability or had any surgeries? *

Yes

No

Applicant Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Drivers License Number *

Banking Information

Name of financial institution *

Account number *

Account type *

Savings

Checking

Do you have a CashApp? If so what is your CashApp name? *

Do you have Zelle? If so what is your Zelle name/number ? *

Authorization *

I authorize [company] to initiate credit entries to the account indicated above for the purpose of expense and/or payroll. I also authorize [company] to initiate, if necessary, debit entries and adjustments for any credit entries made in error.

Signature *

clear

Verification Documents

Please upload a copy of your Government Issued Identification Card. *

Please upload Proof of Citizenship or Social Security Card . *

Work Experience

Previous Employment

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

No

Phone Number

Do you have any philanthropic/volunteer experience? *

Yes

No

If yes, explain. *

The information contained in this application is correct to the best of my knowledge. I hereby authorize and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security numbers and date of birth. *

I do hereby acknowledge the above terms and statements. I also release all personal /proprietary information for such causes.

I do not agree to the terms listed above.

Date * +

Participant name: *

Participant Signature *

clear

I understand that submission of this application makes you subject to a maximum of five hours community service as required by the district in which you are applying. Community service hours vary based upon need. Your employment would then subsequently be at will. This means your employment is for an indefinite period of time and it is subject to termination by you or [employer name], with or without cause, with or without notice, and at any time as designated. *

I do hereby acknowledge the above terms and statements. I also release all personal /proprietary information for such causes.

I do not agree to the terms listed above.

Date * +

Participant name: *

Participant Signature *

clear

For Office Use Only

Authorized Representative (Last Name)

Date * +