Survivor Support Fund Application

Fund Policy *

I have read and understood the Survivor Support Fund Policy.

Defend Dignity recognizes that every application we receive for funding is significant. Due to the number of applications we receive and limited funds available not every application will be awarded funds. We encourage agencies/churches to reapply in the next SSF Intake session if the need is still relevant or a new need has emerged.

Name of church/agency applying *

2. Church/agency contact person *

3. Church/agency website

Street Address *

Apartment, suite, etc

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 *

State/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 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. For what purpose is the person you are applying for in need of access to this fund? IMPORTANT: Please prioritize and list by number the items with dollar amounts for ALL needs that are submitted. As per our policy, any individual can only receive up to $2,000 per calendar year from the Survivor Support Fund. The needs CANNOT exceed $2,000. For example- 1. Credit Card Debt- $500 2. New Bed- $800 etc. *

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.)? *