Community Relief Application

Ripple Effect Community Relief Request

This form is for individuals or families seeking short-term assistance

with essential needs such as rent, utilities, medical bills, or groceries.

Each submission is reviewed with care. Submitting this form does not guarantee assistance.

First name

Last name

Phone

Type of Assistance Needed

Please share any context you feel comfortable providing

If selected for assistance, may we share your story? (Optional)

Yes, but please keep my name anonymous

No, I prefer my story remain private

We may share impact stories to help raise awareness and future support. No personal information will ever be shared without your permission.

How Did You Hear About Ripple Effect? (Optional)

Instagram

Facebook

Friend / Family

Sponsor

I confirm that the information provided is accurate to the best of my knowledge, and I understand that Ripple Effect may request verification before assistance is distributed.

Ripple Effect is a community-supported event. Assistance is dependent on funds raised and will be distributed after the event once totals are confirmed. We understand some situations are urgent, and we will review all requests carefully.

Ripple Effect Community Relief Request

L.A.Y.E.R.S. CLUB