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 a member of SAG-AFTRA/AGMA/AEA/Local 798/Local 802/Local 600/Local USA 829/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!

The Actors Fund and Motion Picture & Television Fund (MPTF) have received generous COVID-19 funding from IATSE, Netflix 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.

What disaster have you been affected by? *
Are you applying for financial assistance? *

Yes No
Which assistance are you applying for (check all that you are eligible for) *

Actors Fund Assistance (If you are an IATSE member, please check here) SAG-AFTRA Assistance, AGMA Relief Fund, IATSE Local 798, Musician Union Local 802, Actors' Equity Association, Local USA 829 IATSE COVID-19 Relief Fund, and/or Producers Guild of America Jujamcyn Theater Assistance Funds Cinematographer Union IATSE - Local 600 Hollywood Support Staff Relief Fund (HSSRF)
First Name *
Middle Name
Last Name *
AKA
Birthday *

Month Day Year
Date
Last 4 digits of SSN *
Street Address *
City *
State *
5 digit Zip *
Region Calc
Region2
Region
Cellular *
Other phone
Email *
Union membership
Union membership #
Occupation *
Marital Status *
Number of dependents and birth dates *

Fill in fields that apply to your situation.
Do you: *
Monthly Rent/Mortgage
Amount in whole dollars
Payable to:
Do you anticipate income over the next two months? *

Yes No
Please let us know the source of the income (eg: unemployment, non-industry) and the amount *
Are you able to meet your monthly expenses for the upcoming month? *

Yes No
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