Member Relief Fund Application Form – Carolinas Credit Union Foundation

The Champion CU Member Relief Fund was established to provide financial assistance in the form of a grant to members who are experiencing financial hardship due to events beyond their control, including disasters and other special situations. The Champion CU Member Relief Fund does not aid with non-emergency situations or financial difficulties due to poor financial management, judgement, or negligence. Assistance for emergencies and crisis situations are considered on a case-by-case basis, and requested funding is not guaranteed.

FUND CRITERIA: the intent of the fund is to provide relief to Champion Credit Union Members who are currently experiencing a financial hardship*. The criteria below are intended to manage limited fund resources and assist people in our community experiencing the greatest hardship. Before applying, please carefully read the qualifying criteria, which includes:

Circumstances involving loss of household income (i.e. job loss). In these situations, the event must have already taken place, and the financial hardship* underway.
Disaster resulting in significant damage rendering the home temporarily or permanently uninhabitable. Please provide photo evidence of this.
Losses not covered by insurance or government relief (FEMA, etc.). In these cases, documents showing the gap in coverage must be included in your application.

*What is financial hardship? In accordance with the IRS, financial hardship must be demonstrated in order to receive grant funding and is understood to mean negative monthly household income, meaning there isn't enough income and limited to no savings to meet your financial obligations. For example, in the case of job loss/closure of a facility, the date of the event is the first day you are no longer working, not the date of the announcement. In this example, assuming you had not found another job of comparable wages, you would apply after losing employment and after your savings reserves, if any, have been exhausted.

LIMITS: please review the following fund limits.

To apply, you must be a member in good standing with Champion Credit Union and must have been a member of Champion Credit Union at the time of the event causing the hardship.
The maximum relief grant amount is $1,000 per household per event/hardship. Only one grant per household can be received in a 12-month period.

NOTE: Grants may take up to five business days to process by the Carolinas Credit Union Foundation, the administrator of the Champion CU Member Relief Fund. Notification on the application status will be provided by the Carolinas Credit Union Foundation via email with funds disbursed to your Champion Credit Union account within two business days of your grant’s approval. A grant is not taxable income.

PERSONAL INFORMATION

Name(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Alternate Phone(Required)

Email(Required)

Reason for hardship (Please check one and note the documentation needed):(Required)

Job Loss

Disaster

Please note that to qualify, applicant must have been terminated or laid off from work due to a disaster. Time off work does not qualify.

If applying for hardship due to job loss, please attach a Letter of Determination from the NC Division of Employment Security and/or your notice of change in employment from your employer. This is required documentation for job loss.

Max. file size: 50 MB.

Please attach unpaid bills.

Drop files here or

Max. file size: 50 MB.

These may include delinquent medical or utility bills, mortgage payments, etc. All bills provided must include the identity of the member applying for relief and be dated around the time of this relief application.

Please provide photo evidence of significant damage rendering the home temporarily or permanently uninhabitable.

Drop files here or

Max. file size: 50 MB.

Applicants who own their home must also be able to demonstrate losses not covered by homeowners insurance or other types of aid (ex. FEMA) in times of major disaster.

Are you an employee of Champion Credit Union?(Required)

Yes

Description of Event Beyond Your Control and Resulting Financial Hardship:(Required)

Total dollar amount of expenses resulting from an event beyond your control.(Required)

Amount of Grant Requested:(Required)

Members experiencing hardship are also encouraged to consider other avenues of support such as 401(k) loans or hardship withdrawals, loan modifications, as well as any government and/or local community programs. Please list all other efforts you have put forth to alleviate your financial hardship.(Required)

Account balances to demonstrate financial hardship:

Checking: $(Required)

Savings: $(Required)

Annual household income: $(Required)

Monthly household income: $(Required)

Monthly household expenses: $(Required)

Number of individuals in your household:

Number of adults:

Number of children:

Please upload any documents that demonstrate the financial hardship you are experiencing.

Drop files here or

Max. file size: 256 MB.

Please upload a photo of your driver’s license for membership and balance verification purposes (this is required for your grant’s consideration).

Max. file size: 50 MB.