Down the Block: Millburn & Short Hills, NJ

WELCOME TO DOWN THE BLOCK, NEIGHBOR!

We're glad you've found us and hope we can help you.
Before you apply, please read this for an overview of our policies and procedures:

Our goal is to confidentially help our Millburn Township neighbors who need short-term assistance because they are facing unexpected financial set-backs. We do this by raising funds to enable us to pay for basic goods or services needed by applicants who have been deemed eligible.

To be eligible, you must be at least 18 years of age, a legal resident of Millburn/Short Hills, New Jersey, and able to honestly prove need.

Down the Block, Inc. screens all applications by requiring documentation. Such documentation includes, but is not limited to, proof of identity, proof of address, proof of income, proof of the circumstances surrounding the request, proof of the expense. For example, should an applicant request the repair of a water heater, Down the Block's requirements would include an estimate from a licensed plumber. (Down the Block reserves the right to require additional estimates.)

Down the Block limits each household to two successful applications.

We encourage you to ask for what you need; but please don't ask for more assistance than you absolutely need. Because of budgetary considerations, requests for smaller amounts are always more likely to be funded. Requests for larger amounts may require additional documentation.

Once you submit an application, our board member will meet with you to review your claim and your supporting documents. She will then present your application to the Board of Directors, omitting all identifying information. The Board of Directors will then determine whether Down the Block, Inc. can fund your request.

Once Down the Block, Inc. has approved an application, payment will be made directly to the goods-provider or service-provider. We never write a check directly to an applicant; rather, we pay for the goods or service that our applicant needs. For example, should you need help paying for a needed home repair or a utility bill, we would pay the contractor or the utility company.

An application that has been deemed eligible will not be funded if Down the Block, Inc. does not have adequate funds to cover the request. In that case, the applicant's request will be reopened as soon as adequate funds become available. Additionally, an application may be deemed ineligible if Down the Block is not satisfied that the information contained in the application is supported by the documents, etc.

Down the Block, Inc. endeavors to strictly protect the confidentiality of its applicants at all times.

APPLICATION

E-mail Address: *
First and Last Name
What document(s) will you be able to provide as proof of identity? (One possibility is a state-issued ID, like a drivers license)
Address, Town
Phone (Home)
Phone (Cell)
How do you prefer that we contact you?	Home Phone Cell Phone Email
How did you learn about Down the Block?
What document(s) will you be able to provide as proof of residence in Millburn/Short Hills? (one possibility is a utility bill in the name of the person who is applying for assistance from Down the Block)
Members of Household (Names, Ages)
Employment Status of Applicamt Employer
Salary (past 12 months)
Income from other sources (past 12 months)
Name of Additional Household Member
Employer
Salary (past 12 months)
Income from other sources (past 12 months)
Name of Additional Household Member
Employer
Salary (past 12 months)
Income from other sources (past 12 months)
Name of Additional Household Member
Employer
Salary (past 12 months)
Income from other sources (past 12 months)
Name of Additional Household Member
Employer
Salary (past 12 months)
Income from other sources (past 12 months)
Name of Additional Household Member
Employer
Salary (past 12 months)
Income from other sources (past 12 months)
What document(s) will you be able to provide as proof of household income for all household members employed over the past 12 months? (possibilities include W2 forms and pay stubs)
Please explain in full what the expense is that you need our help with.
What document will you be able to provide as proof of the cost of meeting this need?
Please explain in full why you cannot afford to pay this expense on your own. (Instead of paying for this good/service, what will your money be spent on?)
I covenant not to sue or make any claim against Down the Block, Inc. and its officers, employees, agents, volunteers and sponsors for death, injury, disability, loss of income or other loss of damage. I agree to hold harmless, defend and indemnify Down the Block, Inc. and its officers, employees, agents, volunteers and sponsors for any trespass to property, damage to realty or personal property, wrongful death or personal injury to anyone or any other loss or damage whatsoever caused by me or my activities in connection to my involvement with Down the Block, Inc. Finally, I agree that the decision of Down the Block regarding my application is final. I covenant not to sue or make claim against Down the Block, its officers, employees, agents, volunteers and sponsors for any application determination or for any cause of action whatsoever including libel, slander, defamation of character, tort of outrage, invasion of privacy, breach of confidentiality or fraud.	I agree. I disagree.
All of the information provided herein is true to the best of my knowledge	I agree I disagree


* Required

Down the Block, Inc. may amend this application as it deems necessary.