Application for Financial Assistance

This is short-term financial assistance. If this application is accepted, you will be only eligible for our financial assistance for two years from the date of your first application.

We respect your privacy. We do not sell or rent your personal information to anyone, including third-party marketers. Your data is used to provide you with current and future services. Your data is anonymized and aggregated for fundraising and measuring impact. Please answer truthfully.

Have you been wrongfully convicted and released? *

Yes

No

Applicant Information

Full Name *

Email *

Phone

Address

Street Address

State *

City

Postal Code

County of Residence *

Social Security Number *

Date of birth *

If you are affiliated with an Innocence Project, please provide the following information:

Name of Innocence Project

Name of Lead Attorney & contact information

Applicant Demographic Information

Incarceration has a significant negative impact on physical, mental, emotional, and social health. Please indicate all you have experienced since your release.

Physical issues (ex: diabetes, high blood pressure, asthma)

Mental issues (ex: anxiety, depression)

Social issues (ex: social isolation, distrust, family disconnection)

Trauma and/or Stress (ex: PTSD related to experiences during incarceration)

common.other_option

How often do you experience trauma or stress related to your wrongful conviction?

What is your highest level of education?

Applicant Financial Information

Have you received compensation?

Yes

No

If yes, what year did you receive that compensation?

Do you have a compensation or civil claim pending?

Yes

No

If yes, please let us know if it is a compensation claim or civil case and when it was started.

Are you currently employed? *

What is the industry of your job?

What is your total yearly household income? *

How many people, including yourself, currently live in your household? *

What is your current living situation?

What is your current credit score?

Have you had any major life events in the last 12 months? Explain. (examples: married, divorced, new family member, death in the family, major car or house repairs, major medical issues) *

Have you been unable to pay a bill in the last 12 months? *

Yes

No

Briefly state what SPECIFIC FINANCIAL HARDSHIP this money will be used for. *

How did you hear about our financial assistance?

Upload any supporting documents - this includes PDFs or pictures of specific needs you stated above. Please make sure the documents include the account holder and any information needed to remit payment. These documents must have your name, account information, and where or how to pay. If the bills are not in your name, please provide an explanation as to why. Examples include rental agreements, phone bills, car repair bills, etc. Uploading these documents is required for the application process. If your file is too large or you have more than 5 files, please email them directly to [email protected] and upload a document stating they will be emailed so we know to look for them

Document upload *

Click to upload

PDF, DOCX, DOC, JPEG, JPG or PNG ( max 5 Files )

By signing, I affirm that the information provided in this application and the accompanying documents is true and accurate to the best of my knowledge. My signature indicates that I authorize The Pruno Fund, Inc. to verify any and all information. I understand and acknowledge that false or misleading statements of a material fact may be subject the applicant to prosecution under applicable laws. I further acknowledge that the Internal Revenue Service has the right to ask The Pruno Fund, Inc. for information, at any time, related to this application and the accompanying documents.

Signature of Applicant or person applying on behalf of Applicant *

Clear

Today's date *