Pocono Mountains United Way's Hospitality and Restaurant Worker Relief Fund

The following information is required and will be used to verify eligibility for Pocono Mountains United Way's Hospitality and Restaurant Worker Relief Fund. Please provide accurate contact information so that we can contact you with any follow-up questions about your application and to notify you if you are selected to receive financial assistance. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

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Are you age 18 years or older? *
Are you able to receive text messages on this phone? *
Are you currently employed or have been employed in the last 60 days by a restaurant or hospitality business? *
Is your household income at or below the amounts shown above based on your household size? *
Have your wages or the wages of others in your household been negatively impacted by the COVID-19 pandemic? *

Are you a family member or do you reside in the same household as a staff or board member of Pocono Mountains United Way? *
By selecting "YES", you are certifying that everything within this application is true and accurate to the best of your knowledge. *
By signing this form and clicking submit you agree and consent that all information provided on this application, including any and all personal and financial data, is accurate and will be used to evaluate your application for the Hospitality and Restaurant Worker Relief Fund. You also agree that you will use any funds provided to address immediate basic needs for yourself and/or your dependents, including rent, transportation, medical expenses, or food. The information entered on this form is confidential and will be stored by Pocono Mountains United Way indefinitely.

I acknowledge that assistance under the Pocono Mountains United Way’s Hospitality and Restaurant Worker Relief Fund is contingent upon, amongst other criteria, my full name, account/invoice/quote number (if applicable), and application status being provided to the third-party payee identified in this application. *
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