Banks Construction - Employee Support Program Webform

Banks Construction Employee Support Program

Assisting Banks Construction employees through temporary hardships by connecting them to financial resources and personalized referrals

Please respond to all questions below to help us determine your eligibility for the Banks Construction Employee Support Program. The information you provide is confidential and will not be shared with your employer. All services are provided by Trident United Way.

First Name

Last Name

Banks Employee ID Number

What ZIP code do you live in?

Please provide your county of residence

How would you like to be contacted?

Please provide your email:

Please provide your phone number:

After reviewing your request, a representative from Trident United Way will contact you within 48 hours, as close as possible to your preferred days and times, using your chosen method of contact.

	How can we help you today? (Choose all that apply)
Housing (rent, utilities, house repairs, rental deposit)	Housing (rent, utilities, house repairs, rental deposit)
Transportation (car repairs, gas, bus tickets, drivers' education classes)	Transportation (car repairs, gas, bus tickets, drivers' education classes)
Food	Food
Health (medical bills)	Health (medical bills)
Child Care	Child Care
Other	Other

Please describe:

How has this temporary hardship affected your budget

1 - Not at all

2 - Very little

3 - Neutral

4 - Somewhat

5 - A lot

Please provide any additional information you would like the client navigator to know before they contact you, including the amount of financial assistance you are requesting.