□ Review enclosed information

□ Complete the enclosed forms

□ Gather supporting documentation relevant to your situation

□ Partner with your ASDS or any manager or above to

complete the electronic application and submission of the

packet to The Homer Fund (you cannot access the

application without your ASDS or manager)

□ Call The Homer Fund at (770) 384-2611 with questions

DIRECT GRANT

APPLICATION PREP PACK

Information necessary to complete a Direct Grant

application

This packet provides the information you will need to apply for a

Direct Grant. This packet IS NOT the Direct Grant application.

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DIRECT GRANT APPLICATION PREP PACK

Below is a chart listing the basic criteria for a Direct Grant. This chart is a very reliable

way of determining if your hardship qualifies for a Direct Grant. It is important to remember

that the circumstances below cover the associate, their spouse or legal dependents ONLY.

Parents, grandparents and siblings generally do not fall in this category . If your situation is

not in this chart, then you most likely will not be able to receive assistance through the

Direct Grant. However, you may inquire about a Matching Grant through your ASDS or

manager.

As a reminder, The Homer Fund will assist when there is an exhibited financial need. It is

possible to have a qualifying event AND a qualifying expense, but not meet the eligibility for

a Direct Grant because you have the financial means to pay the expense you are requesting

from The Homer Fund. As always, you should call a Homer Fund team member at (800) 654-

0688 x12611 with your questions.

Qualifying Event Qualifying Expense (caused by qualifying event)

ILLNESS OR INJURY (recent illness or injury of the associate, spouse or legal dependent, generally within last 3-4 months)

Past due rent or mortgage Past due property taxes Past due basic utilities Necessary home modifications to make

home handicap-accessible REQUIRED Supporting Documentation listed

in following section

DEATH

Essential funeral expenses for deceased associate, spouse, minor children or legal dependents ONLY (most recent income tax return listing deceased as a dependent is required)

Past due rent or mortgage Past due property taxes Past due basic utilities Travel expenses to funeral for parent,

sibling, child ONLY*** REQUIRED Supporting Documentation listed

in following section

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Qualifying Event Qualifying Expense (caused by qualifying event)

NATURAL DISASTER OR FIRE (i.e., hurricane, tornado, flood, ice/wind storm affecting the associate's primary residence)

Security deposit to move into a new residence

Utility deposit to connect basic utilities at a new residence

Uninsured/underinsured necessary home repairs

Homeowners' insurance deductibles* Past due rent or mortgage Past due basic utilities Past due property taxes Food** Clothing** REQUIRED Supporting Documentation listed

in following section

UNEMPLOYMENT (loss of spouse's job or the associate's 2nd job due to lay-off or company closure within past 12 months; Home Depot jobs excluded; REDUCED HOURS ARE NOT COVERED)

Past due rent or mortgage Past due property taxes Past due basic utilities REQUIRED Supporting Documentation listed

in following section

UNINHABITABLE OR CONDEMNED HOUSING (residence is condemned or deemed uninhabitable due to unsafe living conditions, rodent/insect infestation)

Security deposit to move into a new residence

Utility deposit to connect basic utilities at a new residence

REQUIRED Supporting Documentation listed in following section

UNFORESEEN SALE OR FORECLOSURE OF A LEASED PROPERTY (for associates who RENT from a private landlord ONLY; foreclosure of a home owned by the associate DOES NOT fit under this circumstance.)

Security deposit to move into a new residence

Utility deposit to connect basic utilities at a new residence

REQUIRED Supporting Documentation listed in following section

* Covered only after demonstrated need; maximum amount is $1,000

** Food and clothing may be considered under all eligible circumstances; however, eligibility for this expense will be determined on a

case by case basis.

*** Air fare, train fare, bus fare, mileage per diem for travel over 200 miles one-way

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DIRECT GRANT APPLICATION PREP PACK

Information necessary to complete a Direct Grant application

To ensure prompt processing of a Direct Grant, please gather the appropriate documents before

partnering with your ASDS or manager. The application is not complete until we have received ALL

relevant supporting documentation.

ALL applications require:

1. Financial Worksheet (included in packet) 2. Copies of bills for which associate is seeking assistance, for instance:

o Past due rent/mortgage statement o Past due basic utilities (electric, gas, water/sewer only) o Funeral expense statement

3. Proof of qualifying event causing the financial need, for instance: o Doctor's note/LOA o Fire/police report o Layoff/separation notice

4. Fax Coversheet for Direct Grant (included in packet)

Other documentation is required to complete the application. This list is in no way a comprehensive list of documents required. Below is a list of basic requirements based on the qualifying event; however, once the application has been received, additional information not included on this list may be required. The Homer Fund will inform the applicant and their sponsors via email and phone to request additional information. Your prompt attention to the request for additional information is appreciated.

Associates seeking help with establishing a new or temporary residence, must submit a “New Landlord Statement/Temporary Hotel Statement (included in packet).

o This document applies to associates requesting assistance with moving costs into a new rental residence OR with a temporary hotel stay due to a qualifying event.

Associates seeking help with past due rent, mortgage or basic utilities are REQUIRED to submit copies of these past due bills.

o ORIGINAL documents are required whenever possible. Illness or injury – Associates seeking assistance based on an illness or injury are REQUIRED to

provide documentation of the medical circumstance. This can be documented in the following ways:

o If an associate has successfully completed and submitted a Medical LOA form or FMLA form to HRSC, than The Homer Fund should be able to see that documentation through Human Resources records.

o If an associate DID NOT successfully complete and submit a Medical LOA form or FMLA form to HR, then documentation of the dates the associate was unable to work

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must be provided through a doctor’s note, or proof of the medical expenses paid must be provided through a PAID medical receipts (NOT medical bills), or documentation of UNPAID time off from work due to medical reasons

PLEASE NOTE that The Homer Fund DOES NOT require details on diagnosis. We simply need to know that the associate is unable to work during a particular time frame as a result of their doctor's instruction.

Death – Associates seeking help with funeral expenses are REQUIRED to submit a copy of the itemized funeral expense statement.

o Associates seeking help with transportation costs to travel to a funeral of a parent, child or sibling must provide proof of the death of their relative (death certificate, obituary), as well as proof of the cost of transportation to/from the funeral.

Natural disaster – Associates seeking help due to a natural disaster are REQUIRED to submit proof of the natural disaster (i.e., insurance report, insurance documents).

o If the associate is seeking help with repairs, the associate MUST PROVIDE proof of the amount needed to make repairs (i.e., contractor quote) and insurance decision (i.e., amount awarded by insurance, or denial of coverage)

Fire – Associates seeking help due to a fire are REQUIRED to submit a fire report or insurance documents supporting the incident.

o If the associate is seeking help with repairs, the associate MUST PROVIDE proof of

the amount needed to make repairs (i.e., contractor quote) and insurance decision (i.e.,

amount awarded by insurance, or denial of coverage) o If the associate is seeking help with paying the deductible, the associate MUST

PROVIDE proof of the amount of the deductible (i.e., letter from insurance company,

current insurance declaration page) Unemployment – Associates seeking help due to unemployment are REQUIRED to submit a

copy of their separation notice or paperwork from the unemployment office noting the cause of unemployment and date the separation occurred.

Uninhabitable or condemned housing – Associates requesting assistance due to uninhabitable or condemned housing are REQUIRED to submit an inspection report, or other documentation showing how the home is uninhabitable.

Unforeseen sale of foreclosure or a leased property – Associates requesting assistance as a result of the sale or foreclosure on their RENTED residence are REQUIRED to submit proof of the sale or foreclosure. This can be documented through the following:

o Foreclosure notice from the landlord or owner of the rented property o Documentation showing the property is for sale

PLEASE NOTE that this circumstance applies to leased properties ONLY. If an associate provides a foreclosure notice on a property that they own, they still need to provide documentation of the qualifying event that has caused their inability to pay their mortgage and an application should be sent in under that qualifying event’s category.

The Homer Fund 2455 Paces Ferry Road Building C-17 Atlanta, GA 30339 (800) 654-0688 ext. 12611 phone (770)384-2612 fax 5

The Homer Fund reviews an associate’s complete financial picture to help us better understand and appreciate

the associate’s circumstances. Before receiving a grant, an associate must show that he or she can afford their

bills going forward. Please complete ACCURATELY and in its entirety to avoid delays in processing.

How many people live in the associate’s household (including associate)? _____Adult(s) _____Child(ren)

Name Relationship Age Monetary Contributor?

Yes No

Yes No

Yes No

Yes No

Yes No

Your application IS NOT complete without our receipt of ALL relevant supporting documentation (i.e., copies of

past due rent, mortgage or basic utilities). See our web site at

www.THDHomerFund.org/grants/direct_new/supporting_documentation.html for a complete list of required

documents.

Your MONTHLY Household Income: Gross Monthly Income

Associate’s Monthly Gross (Pre-tax) Pay $

Spouse’s Monthly Gross (Pre-tax) Pay $

Contributions From Other Adults In Household $

Child Support and Alimony Received $

Disability Insurance $

Social Security/Pension $

Income from TANF or SNAP (circle all that apply) $

Other Income $

Total $

Your MONTHLY Debt Payment: Monthly Debt

Car Loans $

Credit Cards, Student or Personal Loans (circle all that apply) $

Child Support and Alimony Paid $

Medical Bills (monthly payments ONLY) $

Other (gasoline, auto insurance, church, etc.) $

Total $

Your MONTHLY Living Expenses: Monthly Expenses

(full amount) Monthly Expenses

(Associate’s share)

Current or Proposed Rent/Mortgage (in designated field, provide

associate’s share if split with other household members) $ $

Basic Utilities (electricity, natural gas, water/sanitation) $ $

Homeowners Association fees or property taxes (if not a part of

mortgage payments) $ $

Food $ $

Prescriptions /medical co-pays $ $

Other (cell phone, cable, daycare/tuition, clothing, etc.) $ $

Total $ $

HOMER FUND FINANCIAL WORKSHEET (Must be completed for all Direct Grant applications)

**** This IS NOT the Direct Grant application. Partner with an ASDS, HR manager, ASM, SM or

above in order to complete the electronic application. ****

Rev. 7/16

Associate Name: ___________________________________

Associate ID Number: _______________ Store #: ______

The Homer Fund 2455 Paces Ferry Road Building C-17 Atlanta, GA 30339 (770) 384-2611 phone (770)384-2612 fax Rev. 7/16

Names on lease and other residents:

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

This form is required for all applications requesting assistance with moving into a new apartment/rental home or hotel/motel. Please have your potential landlord or apartment complex complete this form. You may also provide a similar

statement on your landlord’s letterhead with the appropriate information.

ASSOCIATE INFORMATION Associate Name: __________________________________________ Home Depot # or Subsidiary: ____________________

If requesting a hotel for temporary shelter, how long will you need the room? __________________________________

I certify that I have applied for and been approved to move into the property listed below. _________________________________ _____/_____/_____ Associate’s Signature Date

APARTMENT/LANDLORD INFORMATION (for permanent residence)

Apartment Complex Name or Landlord’s Name (please print): _________________________________________________________

Apartment/Rental Home Address: _______________________________________________________________________________

Apartment Complex or Landlord’s Phone Number : (_______) _______-__________ Anticipated move-in date: _____/_____/_____

Apartment Rental House

1 bedroom 3 bedrooms 1 bedroom 3 bedrooms 2 bedrooms 4+ bedrooms 2 bedrooms 4+ bedrooms

Total Amount Needed to Occupy Property:

$_____________ security deposit

$_____________ 1st month’s rent

$_____________ pet deposits

$_____________ other deposits (deposit covers ___________________)

$_____________ TOTAL

Has the associate been approved to move into this property? Yes No

Has the apartment complex/landlord received the security deposit? Yes No

Apartment Complex/Landlord accepts: 3rd party business check certified check money order

All checks for rent and security deposit are made payable to the landlord or apartment complex ONLY.

Please make all checks payable to: ____________________________________________________________

____________________________________________ _____/_____/_____ Landlord/Complex Manager’s Signature Date

HOTEL INFORMATION (for temporary residence)

Hotel/Motel’s Name (please print): ______________________________________________________________________________

Hotel/Motel’s Address: ________________________________________________________________________________________

Daily Rate: $___________ Weekly Rate: $___________ 31-days: $_____________ Phone #: (______)________-____________

Hotel/Motel accepts (credit card IS NOT an option): 3rd party business check certified check money order

__________________________________________ ________________________________________ _____/_____/_____ Hotel/Motel Manager’s Name (print name) Hotel/Motel Manager’s Signature Date

NEW LANDLORD or TEMPORARY HOUSING STATEMENT

Page _____ of _____

Provide details on the events that have led to the request for Homer Fund assistance. Also, be clear about the expenses for which you are seeking help. A transparent picture of the events and the resulting expense(s) will reduce questions and help process your request quicker. Add as many pages as necessary to provide a distinct summary of the current hardship.

FOR WHAT EXPENSE(S) ARE YOU SEEKING ASSISTANCE (i.e., past due rent, utilities, funeral expenses, etc)?

WHAT EVENT(S) TOOK PLACE TO CAUSE YOUR INABILITY TO PAY THIS EXPENSE(S)?

Page _____ of _____