To apply for assistance, please complete the application form below in its entirety

CARES Application for Assistance

I hereby certify the statements above to be true and accurate. I authorize the Juniper Cares Employee Relief Fund Committee to review my application in consideration for financial assistance provided by the Juniper Cares Employee Relief Fund. I understand any assistance funded to me is in the form of a grant and is not payable back to the Employee Relief Fund or to Juniper, unless it is deemed that I falsified the information submitted in my application. I agree if any of the information contained within my application changes prior to receiving any assistance, I will immediately notify the Employee Relief Fund Committee in writing at

By submission of my application for consideration, I certify that the information in this application is true, complete, and correct. I understand that false answers, statements, or significant omissions made by me shall be sufficient cause for denial of assistance and corrective action. Should my request be approved, I agree to the terms set-forth in this application and related policies and procedures.

If you are completing the application on behalf of another person, please provide the following:

Submission Process:

  1. Complete the application, sign, and submit to
  2. The Committee will review your application in accordance with the Juniper Cares Employee Relief Fund.  Based upon the initial assessment by the committee, you will be referred to a Project Manager from Helping Hands Charitable who will gather basic information about your current need.
  3. The Helping Hands Project Manager shall advise the Committee of the financial need maintaining your personal information in confidence.

For Committee Use Only: