UpliftEd Aid Application (Due September 1st - 30th)

Name

Email Address

UPLIFTED AID APPLICATION (Submit September 1st through 30th. A recent tax return is required.) UpliftEd is an emerging nonprofit created to promote community support and retention of high-quality educators in Tulsa Public Schools. UpliftEd partners with the community to offer aid and gifts to Qualifying Teachers throughout the year. UpliftEd is not obligated to provide aid or gifts to Qualifying Teachers, but will solicit and disperse as much aid as we’re able. Please fill out this application to determine if you are eligible to receive aid from UpliftEd. Your identity will be held in strict confidentiality and your information will be used only for the purposes of selecting Qualifying Teachers, helping UpliftEd know how to continue to help teachers, and producing marketing material. We'll respond to your application by email in October. Thank you! UPLIFTED AID APPLICATION (Submit September 1st through 30th. A recent tax return is required.) UpliftEd is an emerging nonprofit created to promote community support and retention of high-quality educators in Tulsa Public Schools. UpliftEd partners with the community to offer aid and gifts to Qualifying Teachers throughout the year. UpliftEd is not obligated to provide aid or gifts to Qualifying Teachers, but will solicit and disperse as much aid as we’re able. Please fill out this application to determine if you are eligible to receive aid from UpliftEd. Your identity will be held in strict confidentiality and your information will be used only for the purposes of selecting Qualifying Teachers, helping UpliftEd know how to continue to help teachers, and producing marketing material. We'll respond to your application by email in October. Thank you! I have read the description above.

1. At which Tulsa Public School(s) are you employed?

2. What type of teaching certificate do you have?

3. How many years of school-teaching experience do you have?

4. How many years have you taught for Tulsa Public Schools?

5. What is your approximate Tulsa Public Schools salary?

6. What is your entire household’s monthly Net Income? (Monthly take-home pay AFTER taxes and deductions)

7. What is your entire household’s annual Gross Income? (Full income BEFORE taxes and deductions)

8. How many people are in your household?

9. Please explain how a financial gift from UpliftEd would help improve your situation.

10. Which of the following expenses place a burden on your financial well-being? Check all that apply. 10. Which of the following expenses place a burden on your financial well-being? Check all that apply. Living expenses Childcare expenses Vehicle expenses Saving Medical expenses Home maintenance/repairs Debt None of these

11. Do you receive government assistance? Check all that apply. 11. Do you receive government assistance? Check all that apply. Women, Infants, and Children (WIC) Supplemental Nutrition Assistance Program (SNAP) Temporary Assistance for Needy Families (TANF) Section 8 Housing SoonerCare Childcare Assistance None of these

12. Have you had to consider any of the following options to improve your financial circumstances? (Check all that apply.) 12. Have you had to consider any of the following options to improve your financial circumstances? (Check all that apply.) Getting an additional job Applying for loans Moving to more affordable housing or acquiring a roommate Moving to a state where teachers are better compensated Choosing a better compensated career Foreclosure Bankruptcy None of these

13. Are you employed anywhere other than Tulsa Public Schools?

Where?

14. Approximately how many hours a week do you work for Tulsa Public Schools?

15. Did you use any of your personal funds for classroom supplies last school year? 15. Did you use any of your personal funds for classroom supplies last school year? No Yes

Approximately how much?

16. As a teacher, how valued and supported do you feel by your community? Use a scale from 1-10, with 1 being “Not Supported” and 10 being “Extremely Supported.”

17. If you’re selected to be part of our Apple Tree Program in November, we’ll publish up to 2 anonymous requests from you that can be fulfilled by donors. (Ex. Home expenses/items, Auto expenses, Medical/Dental expenses, Christmas gifts, etc.) See upliftedschools.org/give. Would you like to submit requests now? 17. If you’re selected to be part of our Apple Tree Program in November, we’ll publish up to 2 anonymous requests from you that can be fulfilled by donors. (Ex. Home expenses/items, Auto expenses, Medical/Dental expenses, Christmas gifts, etc.) See upliftedschools.org/give. Would you like to submit requests now? Yes No, I'd like to think about it longer.

Name two requests you would make in November totaling no more than $1,000. You may have better chances of donors fulfilling your requests if they are lower priced.

Please submit a copy of your tax return from 2019 or 2020 after blacking out the social security numbers. Email it to aid@upliftednew.flywheelsites.com.

Applicant's Full Address

Applicant's Phone #

To your knowledge, do you have any relation (business or familial) to any employee, board member, or volunteer at UpliftEd? To your knowledge, do you have any relation (business or familial) to any employee, board member, or volunteer at UpliftEd? No Yes

Please explain.

By signing, you certify that your answers are true and correct to your knowledge. (Electronic Signature)