Survivor Support Fund Application

I have read and understood the Survivor Support Fund Policy.

Defend Dignity recognizes that every application we receive is significant. Due to the number of applications we receive and the limited funds available, regrettably, many applications will not be funded. We understand it can be difficult when an application can’t be funded, so we want individuals to be aware of these limitations before applying.

Name of church/agency applying *

2. Church/agency contact person *

3. Church/agency website *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country

5. Contact person’s phone number *

6. Contact person’s email address *

7. How did you hear about the Defend Dignity Survivor Support Fund? *

Church/agency has applied beforeFrom another church/agencyIn an email from Defend DignityDefend Dignity websiteDefend Dignity social mediaOther

Specify

Note: The following questions pertain to the applicants themselves.

8. Name of the applicant *

9. Applicant’s date of birth *

City *

Province *

Country

11. Is this person an official Canadian citizen? *

YesNo

11. a. If this person is not a Canadian citizen or has immigrated to Canada, what is their status in the country (e.g. on a visitor visa, work/study permit, refugee status, permanent resident, immigrant, etc.)?

12. a. What race and/or ethnicity is the applicant? *

12. b. If the applicant is Indigenous, do they have official Treaty status?

YesNo

13. What is the applicant’s gender? *

MaleFemaleOther

14. Which of the following has the applicant experienced? Please indicate all that apply. *

Applicant’s intimate images/videos shared online without their consentCammingEscortingMassage parloursPornographySex traffickingStrip club/exotic dancingSurvival sex (trading a sexual favor for ride, money, drugs, etc.)Other

Specify

16. If this individual has been trafficked for the purpose of sexual exploitation, were they trafficked:

DomesticallyInternationally

17. Is the applicant on social assistance from the provincial government (i.e. Ontario Works, Alberta Works, etc.)? *

YesNo

Specify

18. What specifically is the applicant requesting funds for? IMPORTANT: Please list by number the items that are requested in order of highest to lowest priority. Each item must include the dollar amount requested for that item. As per our policy, an individual can only receive up to $1,500 per calendar year from the Survivor Support Fund. The total request CANNOT exceed $1,500. For example- 1. Credit Card Debt- $500 2. Rent - $700 *

19. Please describe why you feel the applicant would benefit from accessing this fund at this time *max 250 words0 / 250

20. Please include information on the length of the relationship between the applicant and the church/ agency. Describe how you have supported this individual. *max 250 words0 / 250

21. Please describe what other attempts the person you are applying for has made to find funding for this specific need. i.e. Funding from other agencies, social assistance, scholarships, loans etc. *max 250 words0 / 250

22. Please describe how you will oversee the applicant’s use of any received funds. *max 250 words0 / 250

23. Please include any additional information you feel may be relevant to this application for funding. *max 250 words0 / 250

Letter From Survivor *

No file chosen

Survivor Support Fund Application

7. How did you hear about the Defend Dignity Survivor Support Fund? *

11. Is this person an official Canadian citizen? *

12. b. If the applicant is Indigenous, do they have official Treaty status?

13. What is the applicant’s gender? *

14. Which of the following has the applicant experienced? Please indicate all that apply. *

15. Please indicate if there was involvement by (select all that apply): *

16. If this individual has been trafficked for the purpose of sexual exploitation, were they trafficked:

17. Is the applicant on social assistance from the provincial government (i.e. Ontario Works, Alberta Works, etc.)? *