Application

Fill the form below to apply for assistance for significant financial hardship

Please note: you will receive an email confirmation on completion of this form if you do not receive an email please contact your Retailer.

Full Name *

Email *

Start Date *

Date you started working for this Retailer

Cause of Hardship *

What is the cause of your financial hardship? (Please provide as much info as you can and attach supporting documents if needed)

Financial Circumstances *

What are your financial circumstances? (Tell us about your usual costs and income, including wages, benefits and any other income, and the amount of the unexpected costs you are facing)

Alternate Funding

Please provide details of any alternative sources of funding that you have explored (e.g. savings, insurance policies, WINZ benefits, student loan deferrals)

Application Amount *

What is the amount you are applying for? ($3000 maximum)

Specific Costs *

What are the specific costs you are facing? (Please provide as much info as you can and attach supporting documents if needed)

I consent to the Trustees contacting you or your Retailer for further information and to advise of the outcome.

Attachments

Your file should be JPG or PDF format, no larger than 2MB in file size.

I have read and understood the Z Foundation Grant Criteria *