Requests for Aid (Personal)

Enter a financial aid request for a personal or individual project. To apply for financial aid for a startup, a microcredit for a company or a community project, use this form.

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Project Name *

Your Name *

Your Email *

Your Role

Project Country *

Lokálna komisia:

Choose the local currency *

please submit your financial information in the local currency

Form mode

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Personal

1) Recipient Data

Date of First Request to EoC

Recipient Name

Recipient Email

Recipient City and State

Family

Single

Married

Separated

Widow

Number of Dependent Children

Number of Other Dependents

Total Family Members *

Level of Education

None

Hlavný

Ďalší

Higher Education (university)

Employment

2) Employment and Family Income

Family Income

# Family members with an income

Family monthly income *

local currency

Other sources of income

please describe

Difficulties

3) Difficulties Faced

Is the EoC financial help expected to have a direct effect?

Direct: The help directly contributes to solve the problem
Indirect: The help covers some expenses while looking for major solutions to the problem

Main Cause of Need (select all that apply)	EoC help will be:

Indirect

Direct

Unemployment or difficulty finding a job

Indirect

Direct

Irregular or unpaid job

Indirect

Direct

Debt

Indirect

Direct

Health Problems

Indirect

Direct

Housing Condition

Indirect

Direct

Family situation (widow, single parent, separated parents)

Indirect

Direct

Lack of family support

Indirect

Direct

Lack of social support (other than family)

Indirect

Direct

Other

IndirectIndirect

DirectDirect

Existence of other aid

Other financial aid *

Yes, the recipient is receiving other financial aid

No, this would be the only source of financial aid

Other source(s) of aid

Focolare (please describe)Focolare (please describe)

Other (public assistance, local church, etc.)Other (public assistance, local church, etc.)

Please describe and explain why the EoC financial help is not enough

Outcomes

Type of Eoc Help & Cause of Need	Problem Solved?			If Yes, Role of EoC Help

Yes

Partial

Yes

Partial

Projects

4) Personal Project

Purposes of the Help

In this section, you will add the specific OBJECTIVES OF THE AMOUNTS TO BE GIVEN and of the HELP RELATIONSHIP established. Objectives are concrete and verifiable, and contribute to the general implicit objective of solving (or mitigating) the need condition identified in the previous section.

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Show me some examples

Situation 1 - Both parents were laid off and have little money to buy food for the family

Economic security: to enable the family to maintain its level of food consumption after the layoff of both parents
Relationships development: to give the children opportunities for sport and youth group activities

Situation 2 - An accident injured a family member and the medical expenses are a burden

Personal education, training, health: support for medical expenses after an accident

Situation 3 - A flood damaged the workshop of a carpenter, leaving him with no tools to perform his work

Economic Security: to enable the carpenter to start working again after a flood partially destroyed his workshop

Situation 4 - The father of the family holds a job which does not provide enough income for his family

Economic Security: to attend 3 years of a course for computer technicians
Personal education, training, health: to allow acquisition of professional skills as computer technicians

Economic Security

Personal Education, training, health

Relationships Development

Actions

In this section, add the CONCRETE ACTIONS needed to achieve the objectives, plus any complementary actions which can contribute to the effectiveness of the help or to solve the main poverty problem.

Situation 1 - Both parents were laid off and have little money to buy food for the family

Use of funds: covering the monthly expense for fruit and vegetables
Non-financial or complementary: addressing the unemployed head of family to local employers
Non-financial or complementary: to signal to the family youth groups active in their area

Situation 2 - An accident injured a family member and the medical expenses are a burden

Use of funds: paying one surgical intervention

Situation 3 - A flood damaged the workshop of a carpenter, leaving him with no tools to perform his work

Use of funds: buying building materials
Non-financial or complementary: the carpenter and his brother make their labor available

Situation 4 - The father of the family holds a job which does not provide enough income for his family

Use of funds: covering 50% of course fee
Non-financial or complementary: to be in contact with centres for employment (if not done by the school) or with EoC entrepreneurs in the IT field

Type of Action

Use of funds

Non-financial (complementary or not related to financial support)

Reciprocity / active participation

Action

Executed?

Yes

Partial

Alternatives Planned

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Financial Request

Outcomes

Comments / Notes

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Requests for Aid (Personal)

Form Defaults

Form mode

Personal

1) Recipient Data

Employment

2) Employment and Family Income

Family Income

Jobs

Difficulties

3) Difficulties Faced

Is the EoC financial help expected to have a direct effect?

Existence of other aid

Outcomes

Projects

4) Personal Project

Purposes of the Help

Actions

Financial Request

5) Financial Request

Length of Help

Outcomes

6) Immaterial Outcomes