By registering to apply and submitting this grant application, I accept the terms of E4E Relief’s Privacy Policy, which policy applies to my registration and grant application, and authorize and consent to the collection, release, disclosure, storage, processing, review, and transfer to the United States by E4E Relief and Foundation For The Carolinas (FFTC), of any and all of my personal information, including, without limitation, name, address, telephone number, email address, banking information, current employment status, employee or personal ID, hire date, work location, medical records, histories, reports, notes, diagnostic reports, diagnostic films or imaging, and all such other information of whatever kind and character, which may be necessary or appropriate to review and process my grant application and to provide services pursuant to my grant application.
I hereby certify that I am experiencing or have experienced the distress or need described in my grant application. I hereby certify that I have done everything possible, including undertaking efforts to obtain the funds from other sources, to help myself before applying for this relief grant. I further certify that the information provided and representations made in this grant application and any attachments to it are true and correct as of the date of this application. I authorize my employer and the Sponsoring Company from which I am seeking a grant (as applicable), to provide any information, including but not limited to any information about me, my relationship to the Sponsoring Company or my employment (if applicable), to E4E Relief as reasonably requested regarding this application. I also authorize E4E Relief to disclose information to third parties, including the Sponsoring Company and my employer, as E4E Relief deems necessary to properly review and process my grant application, to provide or improve services and to effect the payment of an awarded grant. Furthermore, I hereby certify that I am not, and no one in my immediate family is, a director, trustee, officer, senior manager, or other key employee at E4E Relief or FFTC or a substantial contributor to E4E Relief or FFTC.
My signature below acknowledges that I hereby permit and authorize E4E Relief to verify and screen all information provided, including but not limited to any and all information relating to my grant application. This includes, without limitation, making appropriate contacts with, making appropriate disclosures to and receiving appropriate disclosures from the Sponsoring Company, my employer, my creditors, and others to ensure that reported information is accurate. I agree and acknowledge that any intentional misrepresentation or intentional omission of material information as it relates to this application or any attachments to it may be reported to my employer and the Sponsoring Company (as applicable) together with this application and attachments, and will result in immediate rejection of this grant application, forfeiture of any grant, and forfeiture of any and all rights I might have to apply for or receive, now and in the future, any grant from E4E Relief or its funds. I also understand that any such intentional misrepresentation or intentional omission of material information may constitute fraud, which may be reported to the Sponsoring Company and, if applicable, to my employer, and for which I may be liable via civil or criminal action. In addition, I understand that I am not legally entitled to receive a grant from E4E Relief or its funds. In this regard, I agree that neither E4E Relief (including its affiliates) nor Sponsoring Company (including its affiliates) shall be liable to me for, and I hereby release each of them from, any and all costs, expenses, damages, claims, or loss of any kind as may be incurred by me in connection with the grant requested in this application or for anything either of them may do or refrain from doing in good faith, including, without limitation, any action or inaction relating to grant application requirements, grant criteria, application completion, application submission, application review and processing, grant approval or disapproval, grant payment amount, method and timing, and all communications relating to any of the foregoing requirements, processes, or actions. I hereby represent, warrant, affirm, and agree that all information I have provided and all representations I have made in connection with this grant application are truthful and accurate to the best of my knowledge.
Furthermore, by accepting a grant from E4E Relief, I agree to the following: 1) All grant money received will be used solely for the specific expenses described in the application and will not be used for any purpose that violates any applicable law or regulation; 2) E4E Relief reserves the right to conduct an audit of my application and any grant resulting therefrom, and that E4E Relief has the right to obtain verification of any grant expenditures; 3) I agree to cooperate with E4E Relief in its audit and verification efforts and to provide E4E Relief with any documents requested pursuant to such audit and verification; 4) If I am located in the United States, I agree and acknowledge that if the grant awarded to me constitutes income under applicable law, I am responsible for reporting and payment of any federal, state and local income and other related taxes; 5) If I am outside of the United States, I agree and acknowledge that I am responsible for any country, state, province, local or other related taxation or reporting requirements for receiving funds from a US charity that may be imposed; and 6) I agree and acknowledge that any and all grants are provided as gifts.
I agree that this grant application and all notices and disclosures made or given in connection with this application may be created, executed, delivered, and retained electronically. As such, I agree that this application and any related documents may be signed electronically and that the electronic signature appearing on this application or any related documents shall have the same legal effect for all purposes, including validity, enforceability, and admissibility, as a handwritten signature.
