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Relief Grant Application
We understand that the information you will be providing us is personal in nature. Your information will not be shared with your employer or anyone outside of Two Ten Footwear Foundation.

Please note that Relief Grants are limited to one per household.

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Applicant Information





Please enter the date in MM/DD/YYYY format.



Please enter your primary phone number. If this is a mobile number that can receive text messages, we may use it to send important updates.
Home Address






About You

(If due to a natural disaster such as a hurricane, please select 'Natural Disaster' from the drop-down.)





Would you or anyone in your household benefit from any of these additional support counseling services? (Check all that apply)
Two Ten offers free referrals for counseling and support services through our Employee Assistance Program. Select any options that may be helpful for you or your household. You can learn more about the available resources here




Employment Information

You continue to be eligible for a Relief Grant within 6 months of separation
Employer Address
If you have more than one work site, please provide the address of the location where you work most frequently.








Please enter the date in MM/DD/YYYY format.









Applicants are eligible for Relief Grants within six months of separation from the footwear industry

(Numbers Only)
Household Information





This amount should reflect total household income for all earners in the household. (Numbers Only)
Please list all household members other than yourself who currently live with you. Include their full name, date of birth, and relationship to you. Do not enter your own information here — you have already provided that in the applicant section. If you have more than one household member, click â€śAdd Another Response” to include each additional person.
Household Member Information



Please enter the date in MM/DD/YYYY format.

Click 'Add Another Response' to include an additional household member.
Demographics & Additional Information









This is not a requirement to receive a Relief Grant.

This is not a requirement to receive a Relief Grant

Upload Documentation
All documents listed below with a red asterisk* must be included prior to submission.

Please upload your documents in one of the following formats: pdf, jpg, jpeg, doc, or docx. The total file size must not exceed 30 MB (per form submission).

If you are unsure where to obtain any of the requested documents, please contact your Human Resources (HR) representative. They should be able to assist you in accessing employment verification, pay stubs, or other supporting documentation required for this application. 

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Last 2 Paystubs - You are required to show proof of current employment by submitting your last 2 paystubs.


Last 2 Paystubs - You are required to show proof of current employment by submitting your last 2 paystubs. 

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