Community Choice Material Aid Request

This form is to specifically request Material Aid support from the JUNK group.

This form is to be completed by partner agencies supporting the delivery of the Community Choice initiative with the distribution of our program to community members accessing assistance through their services.

It is NOT intended that any questions contained within this form be used as an interview script OR specifically asked of community members accessing assistance through the initiative. We simply ask that partner agencies provide information to the best of their knowledge and ability to assist us in providing suitable support to participants.

Completion of this form should ONLY be done by staff/volunteers of partner agencies supporting the delivery of the initiative.

All data collected within this form related to the community member is confidential and will not be shared beyond. Contact details for community members are only used to assist the JUNK group in the delivery of their services and will not be used by any other agency (including the Give Where You Live Foundation). De-identified data related to gender, age group, household size, cohort and challenges will only be used as per the agreed purposes contained within the partner agreement.