Financial Assistance Application

Note: If you would like to recommend someone for financial assistance, please complete the recommendation form here.

Have you received prior financial assistance from the DeMarion Sankofa Foundation? *

If Yes, please provide the month and year that assistance was received.

What assistance is required? *

If Other, please specify:

Name *

First

Last

Date of Birth *

Street Address *

Street Address Line 2

City *

State *

Postal / ZIP Code *

Phone Number *

Email *

Marital Status *

Please indicate all people living within the household, including applicant. Must include Name, Relationship to Applicant, and Date of Birth. Example: John Doe, Self, 01/05/2000. *

Is anyone in your household pregnant? *

What has caused or contributed to your financial difficulty? Select all that apply. *

Loss of income (ex. lost your job, etc.)
Personal or family difficulties
Medical bills and expenses
Rising cost of living
Other unforeseen circumstances (ex. death in the family, fire, etc.)

If Other, please specify:

Is assistance needed for past (ex. overdue bill) or current (ex. food or upcoming bill) needs? *

What is the estimated or total amount of assistance needed? *

STATEMENT OF ACCURACY FOR APPLICANTS: I hereby affirm that all of the above stated information provided by me is true and correct to the best of my knowledge. I hereby understand that I will not submit this application without all required attachments and supporting information. Furthermore, I hereby understand that incomplete applications and/or applications that do not meet the eligibility criteria will not be considered for this assistance. *

Confirm

Service. Scholarship. Responsibility.
The DeMarion Sankofa Foundation is a 501(c)(3) non-profit organization that is dedicated to serving the Aberdeen, MS community. Our mission is to embody the African principle of Sankofa – to connect the past to the present – and honor Mr. Henry Earl Marion via our acts of community service for the great citizens of this area.