FINANCIAL ASSISTANCE – UNDRIP SUMMIT 1652

FINANCIAL AND OTHER ASSISTANCE

Please Note: We can not guarantee that you will qualify for financial and other assistance, even if you apply.

Have you completed the NDA (Non Disclosure Agreement) & Protocol? *

Date of NDA & Protocol Completion

Have you attended any of the Orientation Sessions? *

Date of completed Orientation Sessions

Have you joined any of the Work Streams? *

Name *

First

Last

GENDER *

Gender

MARITAL STATUS *

EMPLOYMENT STATUS *

INCOME CATEGORY PER MONTH (NETT) *

HOUSING INFORMATION *

Home Address *

City *

Region *

Area Code *

Contact Number *

Email *

Assistance Required

PLEASE PROVIDE US WITH A MOTIVATION WHY YOU SEEK ASSISTANCE FROM UNDRIP SUMMIT 1652 *