Hardship Grant Application - Jimmy Burns Foundation

I found this grant in my search.  It doesn't give an amount, and it does not state what the hardship has to be for.  Also, there is no date of final filing.  This is something you guys may want to fill out and send in.

Here is the link for a clean copy of the application:

I think I am going to send an application in on this as I am curious as to what it is all about.

THE JIMMY BURNS FOUNDATION
Hardship Grant Application
Background: In the spirit of Jimmy Burns, the JBF will grant financial assistance from time to
time to persons in need of help, based largely upon funds available. To apply, simply fill out the
following information and mail to:
*The Jimmy Burns Foundation
P.O. Box 338
Libertyville, IL 60048
General Information:
Last Name______________________First Name______________Middle Initial_______
Home Address____________________________________________Apt. No._________
City______________State_____Zip__________Phone___________Email____________
Hardship Grant Request:
Briefly describe the circumstances supporting your request for financial assistance.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Applicant’s Declaration:
I affirm that all information I have given above in order to qualify is complete, correct and true to
the best of my knowledge. I understand that I may be denied assistance if any of the above is
false, and that I may be required to repay any assistance that I get based on false or incomplete
information.
Upon request, I agree to provide The Jimmy Burns Foundation with evidence of the information I
have given on this application. I understand that this application becomes the property of the
granting Foundation when submitted. Furthermore, I understand that The Jimmy Burns
Foundation may use my name, likeness and or medical condition description in their newsletters,
on their web-site and on other promotional materials used in order to promote fund-raising for its
charitable purposes. By signing below, I hereby give my consent to publish my name, photo and
medical condition for said purposes.
SIGN HERE___________________________________________DATE__________________
* Note that you will be notified of a decision regarding financial assistance following a vote by
the JBF Board of Directors. The response time to requests will vary, based on the timing of
Board of Director meetings.