YWCA Saskatoon - Application/Intake Form (2023)

YWCA Saskatoon – National Emergency Survivor Support Fund (NESS Fund) – Application
YWCA Canada’s NESS Fund provides one-time emergency, financial support to survivors of gender-based violence (which includes: domestic, spousal/intimate partner or family abuse; sexual/emotional/physical violence and abuse and homophobic and transphobic violence and abuse.

For more information on what the term “gender-based violence” means, please click here, to help them leave abusive living conditions, emergency shelters or precarious living situations like staying temporarily with friends/family or living unhoused.

To receive funding, you must:
- Identify as a woman, Trans, Two-Spirit or gender-diverse person
- Be 16 years of age or older
- Not have received NESS Fund support before
- Live in or near an area where the NESS Fund currently operates (GTA, ON; Hamilton and Brantford, ON; Muskoka, ON; Sudbury, ON; St. Thomas-Elgin, ON; Nova Scotia; St. John’s NFLD; Saskatoon, SK; Regina, SK; Brandon, MB; Quebec City, QC; Vancouver and surrounding area, BC).
- Identify as a survivor (someone who has experienced) of gender-based violence (which includes domestic/intimate partner/family violence, sexual/emotional/physical violence and abuse, homophobic and transphobic violence and abuse).
- Be seeking financial assistance to leave violent living conditions OR leave emergency shelters or precarious housing conditions (staying with family/friends; couch-surfing or living unhoused) you were accessing because of experiencing gender-based violence.
The total amount of funding you’ll receive is determined on a case-by-case basis. This decision is made by considering your specific needs, as well as funding availability. You will hear back from a Program Coordinator about the status of your application as soon as possible.

Notes: If you are approved to receive funding, a short and anonymous feedback form will be shared with you. It is an important part of the process to complete it as soon as you receive funding.

For social service workers applying on behalf of community members/program participants/clients: Please note, while our Program Coordinators will provide referrals to applicable community support as deemed appropriate and relevant; we are unable to provide other case-management services to applicants.

Notes on Confidentiality: The information gathered is only shared with the YWCA Canada staff and the YWCA Saskatoon Coordinator(s).

General Information (Applicant or Worker Supporting a Client)
Date of the application:*

MonthDayYear
Date
I or the applicant:*

never applied before.applied but did not receive funding.have/has previously applied for and received funds.
I'm looking for:*

support for me.support for a client.

Contact Details (Worker Supporting a Client)
Please indicate the organization's name:*
Name of the partner organization
Please indicate your name: *

First Name of the workerLast Name of the worker
Your phone number:*
Please enter a valid phone number.
Your email address:*
example@example.com
Do you want us:*

to reach out to the applicant directly?to communicate through you?to communicate with you before contacting the applicant?

Contact Details - Individual Seeking Support
First Name:*
Last name OR initials:*
Year of birth:*
City or Province of Residence*

Street Address

Street Address Line 2

CityProvince

Postal Code
Preferred contact method:*

PhoneEmail
Phone number:*
Is it safe to leave a voicemail/text about NESS Fund at this number?*

YesNo
E-mail:*
example@example.com
Is it safe to leave information about NESS Fund at this email?*

YesNo

Type of Expenses and Amount of Funding Requested

If other, specify the type:
Total amount required:*
In the event that access to the fund is approved, how should funds be distributed most efficiently?*

ChequeExpenses paid directly to a vendor/landlord/service providerOther

	Amount (Total Amount of Maximum $2000)
Rent, rental deposits, and rental arrears prevent applicants from finding new housing
Utilities (Deposits, arrears, set up)
Moving, transportation and storage costs
Furniture for the new housing
Other directly related expenses

Additional Information (Worker Supporting a Client)
Was the applicant given referrals to services or supports offered by the YWCA or allied organizations that could support them in their healing journey?*

YesNo
If yes, what type of referrals were made?*

Statement of Eligibility (Applicant)
The statement below applies to me (check the box below if true):*

The National Emergency Survivor Support Fund is intended for women, Two-Spirit, trans and gender-diverse survivors of intimate partner, domestic or family violence, 16 years of age or older, seeking support to leave dangerous or precarious living situations, leave shelters, or maintain stability/safety after an experience of violence.
This applies to me (check the box below if true):*

I am aware that a short and anonymous feedback form will be shared with me if I’m approved for funding, and that it is an important part of the process to complete it as soon as the funds are disbursed.

Statement of Eligibility (Worker Supporting a Client)
This applies to the applicant:*

The National Emergency Survivor Support Fund is intended for women, Two-Spirit, trans and gender-diverse survivors of intimate partner, domestic or family violence, 16 years of age or older, seeking support to leave dangerous or precarious living situations, leave shelters, or maintain stability/safety after an experience of violence.
This applies to the applicant:*

The applicant is aware that a brief and anonymous feedback form will be shared, and that it is an important part of the process to complete it as soon as the funds are disbursed if eligible.

Information About the Next Steps (Applicant)
Thank you for taking the time to complete this form.
You will be contacted within five business days to discuss your application.
Please note that completing this form does not mean funding has been approved. A program coordinator will be in contact soon to discuss your application.

Information About the Next Steps (Worker supporting a client)
Thank you for taking the time to complete this form.

	Amount
Rental deposit/first or last month's rent
Rental arrears
Utilities set up:
Utilities arrears:
Moving expenses:
Storage expenses:
Travel expenses:
Furniture:
Gender-affirming services:
Settlement related services:
Other:

YWCA Saskatoon – National Emergency Survivor Support Fund (NESS Fund) – Application