Emergency Fund Application Emergency Fund for Diverse Creatives WNDB will provide emergency grants of up to $1000 to diverse authors, illustrators, and publishing professionals in financial need. Name* First Last Please list any former legal names you've had (if applicable)Under Executive Order 13224, all 501(c)(3) organizations must confirm that grant recipients are not affiliated with federally identified terrorist groups. To comply, if you are awarded a grant, we must compile any of your former legal names that have been registered with the United States government. We are aware that we are asking for potentially sensitive information and we sincerely apologize for this intrusion. WNDB will keep this information in the utmost confidence and will never use any former name(s) in our correspondence with you.Address*This fund is for U.S. Residents only. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoUS Virgin IslandsArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhoneArea of diversity with which you identify.*(Check all that apply.) Person of Color Native American LGBTQIA+ Person with a disability Marginalized religious or cultural minority Please mark why you are applying for an emergency grant.*(Check all that apply.) Loss of income due to the pandemic Loss of income (general) Medical expenses Disability Caregiving costs (childcare, elder care, etc.) Natural Disaster Eviction and/or homelessness Domestic violence Death in the family For authors and illustrators, please list your publication history (title, publisher, publication year.)Authors and illustrators must have at least one traditionally published book. We currently are not accepting submissions from self-published creators.For publishing professionals, please list your current or most recent employer and your position title.What is your current or recent monthly income?*Please provide sources and amounts.Please list other income you have received or will receive this year.Please provide sources and amounts, such as royalties, advances, other grants, etc.Please list your estimated monthly expenses.*This includes rent/mortgage, utilities, insurance, etc. How many people are in your household?Please list their names, ages, and their relationship to you.Please provide contact information for your employer or clients who can verify your work history.*Are you eligible or registered for unemployment?*YesNoDo you have PTO or severance available to you?*YesNoPlease provide a statement of need and how you would use these funds.*Maximum 250 wordsPlease attach a copy of your most recent bank statement.*Attach screen shots, images, etc. Use PDF, JPG or PNG files. We suggest blocking out bank account numbers and other sensitive information. Drop files here or Accepted file types: pdf, jpg, png.