Grant Application

Apply for a grant.

Federal law prohibits the Staples Share Fund from making any grants designed to replace or supplement Staples’ compensation or benefits to its associates, including covering any deductibles from Staples’ plans or lost wages due to a reduction in hours. Due to this law the Staples Share Fund CANNOT PROVIDE GRANTS TO HELP PAY FOR MEDICAL EXPENSES.

Staples Share Fund grants must be for qualifying event, such as an illness or injury, death, natural disaster, unemployment, foreclosure or sale of a rental property, domestic abuse, or military deployment has occurred to you or an immediate family member in the past 6 months.

Every request submitted by Staples associates is reviewed.

IMPORTANT: If applying on behalf of another associate, please fill out the form using that person's Name, Employee ID, address etc.

First Name *

Last Name *

Employee ID *

Phone *

Email *

Home Address

City

State

Zip

Staples Facility/Store Location

If applying on behalf of another associate, please describe your relationship to this associate:

Event Type *

What is the reason for your request for assistance? Please provide details about qualifying event and how this event impacts you/the applicant financially (1024 character limit). *

List any other assistance you/the applicant have applied for, are receiving or have received for this event (e.g., insurance, American Red Cross, Salvation Army, food pantry, etc.). *

Explain in detail how you/the applicant will use the grant funds, if received (IMPORTANT: Federal Law prohibits the Staples Share Fund from providing grants to be used to pay medical deductibles from Staples’ plans or to cover loss in wages due to reduction in hours. 1024 character limit): *

The Staples Share Fund may request additional documentation in support of the qualifying event (ex. receipts, invoices/bills etc.). Will you be able to provide this information? *

Yes

No

If no, please explain why.

Occasionally we feature Share Fund stories internally and externally. Please indicate if you are willing to share your story. You can choose to remain anonymous and a member of the Communications team will contact you to confirm detail before sharing further. If you are applying on behalf of another associate, please select ‘No’ unless that associate has given you permission to share his or her story.

Are you or the associate you are applying on behalf of willing to share story? *

Yes

No

NOTE:

• The Staples Share Fund may request additional documentation in support of the qualifying event.

• Financial Assistance is at the discretion of the Staples Share Fund and is not an employee benefit.

• Donations do not ensure eligibility.

By submitting this application, under penalty of perjury, I declare, to the best of my knowledge and belief, that (i) the above stated information is true and correct and (ii) because of the circumstances described in this application, I or the applicant is experiencing a severe financial hardship. Additionally, I authorize the Staples Share Fund to use this information and other information that it may collect in determining my qualifications for receiving a grant, including disclosing such information to others as necessary outside of the Staples Share Fund. If I am applying on behalf of another associate. I agree not to disclose the fact that I applied to the Staples Share Fund on behalf of such associate to others outside of the Staples Share Fund. I understand that funding from the Fund is not guaranteed or a specific benefit of my employment. Any grant, if made, is from the Staples Share Fund and not Staples, Inc. I certify that if a grant is received it will only be used for my expenses incurred in connection with the situation described in this application. I authorize the Staples Share Fund to disclose my name and grant amount, if a grant is issued, in furtherance of its purposes and legal requirements.

By checking this box, you acknowledge that applying based on false pretenses, or submitting false or inaccurate information, can subject you to employee discipline, up to and including termination.