Charitable Assistance Recipient Acknowledgment Harvest Justice Fund – Direct Support Allocation This form confirms receipt of charitable assistance. No services are required.Fiscal Sponsor: Studio @ 550 Program: Neighborhood Grow Plan (NGP) Period: 2025–2026Recipient InformationFull Legal Name(Required) First Middle Last Suffix Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Assistance DetailsAmount: $956 This assistance will be issued as a check made out to the name you enter on this form and mailed to the address listed above.AcknowledgmentBy signing below, I confirm that: Purpose of Assistance I understand this payment is charitable assistance provided to help relieve personal financial hardship and support basic needs. No Services or Participation Required This assistance is not compensation. No work, services, participation, or deliverables are required or expected in exchange for receiving this assistance. No Obligation or Quid Pro Quo Receiving this assistance does not create an employment, contractor, or program obligation now or in the future. Use of Funds I may use the funds at my discretion for personal or household needs related to financial hardship. Accuracy I confirm that the information I provided regarding my need for assistance is true to the best of my knowledge.Name(Required) First Middle Last Suffix Date(Required) MM slash DD slash YYYY Agreement(Required) I have read and agree to the Charitable Assistance Recipient Acknowledgment Δ
