Ellicott City Partnership Emergency Relief Fund Request Form

Ellicott City Partnership

Emergency Relief Fund Request Form
The Ellicott City Partnership is issuing Emergency Relief Grants in amounts of $500 or less to Ellicott City residents, merchants, and property owners. The purpose of this fund is to assist those affected by the flood with their immediate needs not covered by government programs or other resources. Please complete this form, which should be returned to Executive Director Maureen Sweeney-Smith ([e-mail]) or mailed to the Ellicott City Partnership, P.O. Box 92, Ellicott City, Maryland 21041. Our Executive Committee will be evaluating and fulfilling requests on a rolling basis in accordance with our existing conflict of interest policy.
Name: Phone:
E-mail:
Current Address:

Former Address (if applicable):


Are you a: ( ) Resident ( ) Business Owner ( ) Other (Please explain)
Landlord (if applicable):
What amount are you requesting?
For what purpose?




EMERGENCY RELIEF GRANT REQUESTS MUST BE SUBMITTED BY AUGUST 22, 2016. ALL REQUESTS NOT POST-MARKED BY THAT DATE WILL BE REFERRED TO THE LONG TERM NEEDS GRANT PROCESS.