Financial Assistance Grant Application

Village Rising was established as a community fund to bring hope to California residents after disaster strikes, starting with our friends and neighbors in Westlake Village, CA. Our current focus is to provide short, medium, and long-term support to the Oak Forest community in their time of greatest need immediately following the destruction of the Woolsey Fire. Westlake Village residents’ needs comprise a spectrum, from serious to legitimately catastrophic. The purpose of this program is to enact the Westlake Village community value of being there for one another through mutual support and compassion.

Village Rising is dedicated to transparency and will report data on the total funds raised, number of families helped, and the total funds awarded, on a regular basis. Please note, all responses to this application will be held in confidence by the Malibu Foundation, the Village Rising Advisory Council, and select members of Players’ Philanthropy Fund (our fiscal sponsor). Upon review of the present application, 3 of the following forms of documentation will be requested:

  • Verification of Employment and Loss of Income form

  • Proof of State Disaster Unemployment Application

  • Proof of FEMA Application

  • Bank statement(s)

  • Proof of homeowner's insurance status

All fields marked with * must be completed for the application to be received and processed.

Section 1 - Personal Data
Applicant First and Last Name *
Applicant First and Last Name
Applicant Date of Birth *
Applicant Date of Birth
This is the address that was affected by the fire.
Phone *
Phone
Please include all children and/or elderly requiring assistance.
Are you a Homeowner or Renter *
If you selected 'Renter' above, enter $0 in this field
$
Did you have renters' insurance? *
If you selected 'Homeowner' above, select 'N/A' for this field
Section 2 - Declaration of Income and Expenses
Include all members' annual salaries, wages, social security, retirements - before taxes.
Please list the total current balance for all checking, savings, and investment accounts held by you or your spouse/domestic partner.
Note that documentation will be required so that we can ensure funds are distributed in a transparent manner and commensurate with need.
Account No. 1
Type of Account *
$
Account No. 2
Type of Account
Only select one if applicable
If not applicable, leave blank
If not applicable, leave blank
$
Account No. 3
Type of Account
Only select one if applicable
If not applicable, leave blank
$
Account No. 4
Type of Account
Only select one if applicable
If not applicable, leave blank
If not applicable, leave blank
$
Please list any significant non-liquid assets (such as real estate holdings, businesses, vehicles) and their estimated values.
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
Please list the most recent balance of all liabilities, including, but not limited to auto loans, credit card accounts, mortgages, and medical expenses.
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
Please list expected monthly expenses (electricity, rent, telephone, utilities, etc, taxes, car or medical insurance premiums)
$
$
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
Please list any unusual expenses you expect to incur in the next 12 months, either as a direct result of the Woolsey Fire or otherwise.
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
If not applicable, leave blank
If not applicable, leave blank
$
Section 3 - Woolsey Fire Information
Do members of your household have physical or mental health needs that you need assistance with due to the fire? *
For example, elderly persons or individuals with disabilities requiring specialized care.
Would you like resources for counseling services / trauma relief? *
To be provided at no charge
Following the Woolsey Fire, have you applied for SBA loan for a new mobile home and personal property? *
If you have applied for an SBA loan, what was result?
Completion of a Verification of Employment and Loss of Income Form will be required from employer.
Following the Woolsey Fire, if you applied with Federal Emergency Management Agency (FEMA), what was result? *
FEMA offers a maximum of $35,000 to those without homeowners’ insurance.
$
Have you applied for disaster-related unemployment compensation? *
Have you applied for disaster-related food assistance? *
e.g., non-profits, GoFundMe or other fundraising campaigns

Full Name
Date Submitted
This is where we will send funds if approved.

After successfully submitting, a thank you message will appear on the screen to verify we received your submission.