Application for Emergency Financial Assistance

Application for Emergency Financial Assistance
Please be sure to collect all of the required documentation PRIOR to filling out this application. Applications submitted without the proper information will not be processed.

If you are applying due to the Fires or Hurricanes, please proceed to the check box.

For COVID Relief

If you are a member of SAG-AFTRA/AGMA/Local798/Local 802/Local 600/Local USA 829/Local 52/PGA, please be sure to select the fund that corresponds to your Union when asked "Which assistance are you applying for?" and upload your Union Card or Membership Verification Letter (PGA Only).

The Actors Fund and Motion Picture & Television Fund (MPTF) have received generous COVID-19 funding from IATSE, Netlifx and SAG-IACF to assist film and television workers. If you live in Southern California, please apply to only ONE of these two organizations so together we may help as many people as possible. Grant Applicants to The Actors Fund may not also apply to MPTF for COVID-19 assistance. The Actors Fund and MPTF reserve the right to share names and coordinate grants to COVID-19 applicants.
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By checking this box, you indicate that you have read and understand the eligibility requirements and documentation instructions, and that you have prepared your documentation for upload to the online form.

Please enter monthly income amounts: *

	Current monthly income amount
Employment
Unemployment Benefits (UIB)
Pandemic Unemployment Assistance (PUA)
Social Security
Pension
Public Assistance
Other Income Source

Total monthly income
This is a total of the previous question. No entry necessary.
Total prior year's Annual income (including unemployment benefits) *
Please describe your employment and income situation *
Do you: *
Monthly Housing Cost (Rent/Mortgage/Maintenance) *
Amount in whole dollars
Payable to:
Do you anticipate income over the next two months? *

Yes No
Are you able to meet your monthly expenses for the upcoming month? *

Yes No
Assets

Please sum the total amount of all Checking and Saving accounts in the fields below. If you have any investments (i.e. Stocks, bonds, money market, etc) or other assets, please also list them in the appropriate field(s). Do not include retirement accounts. If a field does not apply, please enter 0.
Checking Balance *
Amount in whole dollars
Savings Balance *
Amount in whole dollars
Investments *
Amount in whole dollars
Other *
Amount in whole dollars
Approximate performing arts and entertainment income for the last five (5) years: (with year 1 being the most recent year)
Year 1:
Amount in whole dollars
Year 2:
Amount in whole dollars
Year 3:
Amount in whole dollars
Year 4:
Amount in whole dollars
Year 5:
Amount in whole dollars