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Relief Grant Application
Welcome to Two Ten Footwear Foundation Relief Fund application.

We understand that the information you will be providing us is personal in nature. Your information will not be shared with your employer. Select application data and survey responses will be shared with our evaluation partner in a form that does not identify you.

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


Not ready to finish in one sitting? You can save your progress and return later.
Just check the box at the top of this page labeled “Save my progress and resume later."

Please note that Two Ten does NOT provide relief grants to support any of the following examples:
  • Bills: Credit Card, Phone (mobile and landline), Cable/Internet, Veterinarian Bill, Legal Fees.
  • Loan payments: This includes student loan, consolidated debt, and personal loans used towards large expenses.
  • Taxes: Current and back taxes (property, income, etc)
  • Travel/Moving Expenses: Plane tickets to travel for funeral/services, moving costs (U-Haul, gas, new furniture/appliances not due to an emergency fire/flood)
  • Vehicle Maintenance Costs: Cosmetic alterations to vehicle, oil change, windshield wipers, new tire (unless due to nail/flat while driving), brakes, electrical system, etc. If your car cannot be repaired, a downpayment for a vehicle does not qualify.


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)

When sending a screenshot or picture of your Date of Hire document, the date the photo/screenshot was taken MUST be included on the document.
Last 2 Paystubs - You are required to show proof of current employment by submitting your last 2 paystubs.

When sending a screenshot or picture of your Date of Hire document, the date the photo/screenshot was taken MUST be included on the document.
Last 2 Paystubs - You are required to show proof of current employment by submitting your last 2 paystubs. 
Household Information





(Multi-Generational households are when 3 generations live within the same home)

This amount should reflect total household income for all earners in the household. (Numbers Only)

This amount should reflect total household income for all earners in the household. 
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).

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