The Invictus Fund NV Application Form

Eligibility: The Invictus Fund NV will provide assistance to individuals and families who lost their homes or suffered other financial hardships due to the 2020 Napa County fires. Assistance will be granted based on the needs established on the application and the availability of funds.

Confidentiality: All of the information provided on this form will remain confidential and will be available only to those who need to confirm eligibility of assistance and to those who process the assistance provided.

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Applicant Information

Name

Address

Address 2

City

State

Zip

Employer (if applicable)

Phone Number

Email

Please read through the categories of events/incidents eligible for assistance below and select the category or categories that best describe your unexpected and unavoidable emergency situation. This may be a past incident that has caused you financial hardship and is now preventing you from meeting your needs.

Home loss

Insurance issues

Medical

Transportation

Financial

Childcare

Moving expenses

Loss of income or incoming-producing resources

Other:

Please describe the damage or financial loss relating to your primary residence, including damage to building, land, and real estate or to personal property:

Please describe your specific financial needs (i.e., assistance with bills, rent/mortgage, funds to offset damages not covered by insurance, lack of insurance, moving expenses, other):

Are your losses covered by any insurance policy or other source of funding, such as crowdfunding vehicles?

Yes

No

If ‘yes’ please state the type of coverage and dollar amount(s) covered:

(Please note that, regardless of current insurance coverage or other forms of assistance, all applicants are eligible for immediate financial assistance from the Invictus NV Fund.)

I attest that I have answered the questions on this form truthfully.

Submit application

The Invictus Fund NV is a California nonprofit public benefit corporation and has been granted 501(c)(3) tax exempt status.