Fondation Familiale Vinesh Saxena - Application for assistance

Application form

Please complete the following form if you would like the Vinesh Saxena Family Foundation to consider your profile for financial assistance.

Information

Relevant person

You will receive confirmation by e-mail.

First name *

Last name *

Email *

Mobile

Address *

City *

State/Province *

Zip/Postal code *

Your age

Information about current employment

Position

Employer

Situation: *

Alone Couple

Number of dependents (children and/or partener) *

Describe your situation and the help you need ? *

Check one or more boxes to indicate the situation in which you would like assistance. *

Desired amount: *

Have you tried to get help from relatives, charities or others ? *

Yes No

If yes, explain :

Description of your monthly income *

Income

Salary

Government assistance

Family assistance

Other

Description of monthly expenses *

Expenses

Rent

Food

Bills (electricity, internet)

Supplies (clothing, gasoline, etc.)

Other expenses (daycare, school, etc.)

The household's monthly budget: *

Total income

Total expenses

Have you read the seven principles? Which principles would you like to apply in your daily life? *

Click here to discover them : the 7 Principles