Old Application

Please fill out this short application for assistance. All required boxes must be completed or your application will not be considered.

Important to Know:

In addition to the completed application, you must include at least two (2) images of bills that you are requesting assistance with paying.
All grant requests must be less than $500. If you are seeking more than $500 in assistance, you will need to contact one of our Partnering Agencies*. (This list is offered as a courtesy; assistance criteria may vary by agency.)

The fulfillment of assistance requests is completely dependent upon availability of funds.
The 30-Days Foundation cannot guarantee any assistance grant or specific amount.

Agencies/Advocates - Please fill out this form on behalf of your client and include the agency you are part of in the additional information box.

Thank you for contacting The 30-Days Foundation.

Personal Information

* Indicates required field

Name *

First

Last

Email *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

County *

Have you received help from The 30-Days Foundation in the past 12 months? *

Yes No

Request Information

Please provide us with 2-3 bills that we can evaluate. This will ensure that we are able to help in the most effective way possible.
It is required that you submit 2 bills to us for evaluation, this includes an image or PDF of the bill. You will not be able to submit your request if these questions have not been answered. Again, your request must be less than $500 to be accepted.

Bill #1 Category *

Bill #1 image or PDF *

Max file size: 20MB

Bill #2 Category *

Bill #2 Image or PDF *

Max file size: 20MB

Bill #3 Category *

Bill #3 image or pdf *

Max file size: 20MB

Final Questions

How did you find out about the 30-days foundation? *

Any other information we need to know about your requests? *

Submit

Grant Application

Personal Information

Request Information

Final Questions