Mutual Aid Fund Request Form

All information is confidential and will only be used to guide fund distribution.

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Please fill the following^*

Funds are distributed through e-transfer therefore an email address is required.

First Name^*

Last Name^*

Email^*

Phone Number

Neighbourgood^*

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What type of assistance are you seeking? (Select all that apply)^*

Why we ask this: Understanding what people need most helps us allocate funds effectively and advocate for systemic change. Patterns in requests guide our future programs. For example, if we see many rent requests, we know eviction prevention needs to be a priority.

Rent / Housing costs

Utilities (Hydro, water, heating)

Groceries / Food

Transportation (bus pass, gas)

Childcare

Medication / Healthcare costs

Winter clothing / Essentials

Other

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Do you identify as part of the African, Caribbean, or Black diaspora?^*

Why we ask this: We reserve 70% of funds for Black working-class individuals and families to address systemic barriers. This helps us ensure funds reach those most impacted.

Yes

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How many people are in your household?

Number of people^*

Include children under 18?^*

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Please sign here^*

I confirm that the information provided is true and accurate. I understand this is mutual aid, not a transaction.

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Thank you

We'll reach out soon to follow up with you.

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