Lending A Hand Foundation Application | LeaderOne Financial Corporation

All information submitted with the application for assistance will be used only for internal purposes on decision making

What is your affiliation with LeaderOne Financial and how did you hear about the LeaderOne Lending A Hand Foundation? (required)*

Applicant Name: (required)*

Street Address: (required)*

City: (required)*

State: (required)*

Zip Code: (required)*

Phone*

Email: (required)*

Please provide a detailed explanation surrounding your situation, including dates, as to why you are requesting to be a grant recipient.*

How many adults in household?

How many dependents in household?

Currently monthly income from all sources (per adult) (+) $*

Current monthly expenses (-) $*

Total Monthly Amount Remaining (Please subtract your expenses from your income and provide it here.) (+/-)*

Do you currently own or rent your home?*

What is your monthly mortgage or rent payment?*

Are you at immediate risk of foreclosure or eviction?*

If yes, please provide detailed explanation and timeline.*

*No more than $5,000 able to be requested*