SMITH CHARITABLE FUND GRANT APPLICATION

ELIGIBILITY: The Smith Charitable Fund provides grants of $500 or less to address critical needs for
individuals and families facing residential evictions where those needs cannot be met by other
sources. While income is not a bar to a grant award, priority will be given to applicants at or below
200% of the Federal Poverty Guidelines at the time application is made. Applications must be
approved by the Grant Administrator, who has complete discretion whether or not to award a grant
and to whom it is payable, regardless of this preamble except that, at a minimum, the grant must be
used for and related to residential eviction. If approved, the application will be forwarded to the Law
Foundation of Berks County for payment. No more than one grant will be awarded per twelve-month
period. Applicants may be required to obtain budget counseling.

Date of request: ____________________

Name(s) of Applicant(s), the Individual/family the grant will assist:__________________

______________________________________________________________________________

Address of the individual/family: _____________________________________

_____________________________________

Number and age(s) of children residing at address above (if applicable):

______________________________________________________________________
______________________________________________________________________

Gross monthly income of those residing in rental property: ______________________

Amount of monthly rent: _______________ Amount in arrears, if any ______________

End of lease term, if known: _____________ List any critical deadlines (e.g. lockout, court hearing,
Order of Possession):_______________________________________________________

______________________________________________________________________

Amount of request: ____________ Payable to: _______________________________

Address of payee: ______________________________________________________

Explain the reason for the request, attaching any documentation that supports the request for funding
(e.g. utility bill, lease, eviction complaint,
etc.):__________________________________________________________________
List organizations with whom those residing in the above address have applied for assistance for this
matter, including contact information and set forth result of
application:_____________________________________________________________

______________________________________________________________________

List grants and assistance awarded for housing in the last two years to those residing at the above
address:

Name and contact information of source (caseworker, attorney, social worker, etc.) recommending that
the Applicant apply for the grant.

_____________________________________ _____________________________________________

Grant Administrator Executive Director, Law Foundation of Berks County