1. EMERGENCY FINANCIAL ASSISTANCE / MAP FUND APPLICATION
H Emergency Financial Assistance – For Basic Needs
H MusiCares MAP Fund – For Addiction Recovery Needs
MusiCares may grant financial assistance for needs that have arisen due to unforeseen
circumstances such as: rent, car payments, utilities, prescriptions, medical/dental expenses,
psychotherapy and other expenses related to these categories. The MusiCares MAP fund may
grant financial assistance for needs related to substance or addiction problems which may
include, but are not limited to: substance abuse treatment, psychotherapy, aftercare expenses,
sober living, prescription costs, psychiatric care and other expenses related to these categories.
ELIGIBILITY REQUIREMENTS AND PROCEDURES
Applicants must be able to document participation in one of the following areas:
• At least 5 years of employment in the music industry
• At least 6 commercially released recordings (singles)
• At least 6 commercially or promotionally released music videos
Please include the following required items with the completed application:
(Our staff is available to assist with the completion of the application and attachments.)
• Copies of bills for which assistance is being requested
• Detailed music industry background documentation (articles, liner notes,
letters from employers, etc.)
• A resume or discography
• A copy of your most recent bank statement(s)
• A copy of your most recent tax return
Once the application is received by MusiCares, our Health and Human Services staff will
contact the applicant to review the application and gather additional information if necessary.
A summary of the situation will be compiled and forwarded to the Emergency Financial
Assistance Eligibility Committee for approval. The applicant will be notified of the committee’s
decision as soon as possible. Except in an emergency or crisis, please allow at least one to two
weeks for processing.
ASSISTANCE LIMITATIONS
When financial assistance is provided by MusiCares, it is charitable in nature and therefore,
before seeking such assistance, applicants are required to investigate all other possible sources
of aid. All approved assistance is paid directly to a creditor/third party. At its sole discretion,
MusiCares reserves the right to deny or approve financial assistance.
MusiCares for Music People
EAST
Toll Free Number: 1.877.303.6962
•
11 W. 42nd Street, 27th Floor New York, NY 10036
•
Phone: 212.245.7840 Fax: 212.245.8130
MUSICARES.COM

2. MUSICARES APPLICATION FOR EMERGENCY FINANCIAL ASSISTANCE / MAP FUND
Name: _______________________________________________________________________________________
(As it appears on your Social Security Card)
Recording Academy Member? H Yes H No Member Number: __________________________________________
(Applicants do not have to be a Recording Academy member to receive assistance – for statistical purposes only)
Professional Name: ____________________________________________________________________________
(If different)
Spouse/Partner Name: __________________________________________________________________________
(If applicable)
Home Address: _________________________________ City/State: _____________________ Zip: _____________
Mailing Address: ________________________________ City/ State: _____________________ Zip: ____________
(If different)
Daytime/Evening Phone Number: ________________/________________ Cell Phone Number: ______________
Email Address: ________________________________________________________________________________
Social Security Number: ________________-________-__________________Date of Birth: _________________
Education: H Some High School H H.S. Diploma/GED H Some College H College Degree H Advanced Degree
Ethnicity: H African American H Asian-Pacific Islander H Biracial H Caucasian H Latino
H Native American H Other
(For statistical purposes only – optional)
Marital Status: _____Number of Dependents_____Ages of Dependents__________________________________
Is your spouse/partner employed? H Yes H No If yes, employer information: ___________________________
____________________________________________________________________________________________
PROFESSIONAL CAREER HISTORY:
Please state how many years you have been employed in the music industry: _______________________________
In what capacity? ________________________________________Primary Genre ___________________________
Do you have any commercially released recordings and/or videos? H Yes H No
If so please list: _______________________________________________________________________________
Do you play an instrument(s)? H Yes H No If yes, please list: ________________________________________
(It is required that you attach your work history documentation such as a resume or discography to this application.)
Are you currently employed outside of the music industry? H Yes H No If so, where? ____________________
You may be eligible for additional assistance from other relief organizations. Are you or your spouse a member
of any entertainment unions? H Yes H No
If yes, please list: ______________________________________________________________________________
MEDICAL INFORMATION:
Are you currently receiving treatment for any medical issue? H Yes H No
If so, what?___________________________________________________________________________________
Are you able to work?: H Yes H Limited H No Are you taking any medication: H Yes H No
If so, please list (name, dosage and amount taken) ___________________________________________________
Have you ever been hospitalized and/or treated for a psychiatric and/or addiction issue? H Yes H No
If so, when? _______________________________________Where? _____________________________________
Physician(s) Name: _________________________________Address/Phone: ______________________________
_____________________________________________________________________________________________
Do you have health insurance? H Yes H No Medicare? H Yes H No Medicaid? H Yes H No
Insurance Company: ___________________________________________________________________________
Do you have dental insurance? H Yes H No Company Name: _________________________________________

3. HOUSING: (If applying for housing assistance, a copy of current lease or mortgage coupon is required.)
Number of people in your household: _______ Monthly Rent/Mortgage: $___________Your share: $ ______________
Current amount in arrears: $___________ LEASE/LENDER INFORMATION: (circle one) Name: ____________________
Address: ___________________________________________________ Phone: _____________________________
TRANSPORTATION:
VEHICLE INFORMATION: Year/Make: ________________________ Model: ________________________________
Car Registration Current? H Yes H No Insurance Current? H Yes H No Payment Current? H Yes H No
Loan Balance: $________________________ Legal Registered Owner: ____________________________________
SECOND VEHICLE INFORMATION: Year/Make: _____________________ Model: ____________________________
Car Registration Current? H Yes H No Insurance Current? H Yes H No Payment Current? H Yes H No
Loan Balance: $________________________ Legal Registered Owner: ____________________________________
Have you been and/or are you currently receiving any other financial assistance from another organization(s)?
H Yes H No If so, who? __________________________________________________________________________
When? _____________________________________How much? __________________________________________
MONTHLY BUDGET FORM
INCOME: EXPENSES:
Income from Work $ ________ Rent/Mortgage $ ________
Residuals and Royalties $ ________ Second Mortgage $ ________
Unemployment Insurance $ ________ Home Insurance $ ________
Social Security Income $ ________ Maintenance $ ________
Social Security Disability $ ________ Homeowner’s Association Fee $ ________
SSI (Supplemental Sec.) General Relief $ ________ Food $ ________
Food Stamps $ ________
Veteran Benefit $ ________ UTILITIES:
Spouse/Partner’s Income $ ________ Gas $ ________
Alimony $ ________ Electric $ ________
Child Support $ ________ Water/Sewer/Garbage $ ________
Union Pension(s) $ ________ Telephone/Fax $ ________
$ ________ Cell Phone/Pager $ ________
Fund/Interest $ ________ Cable/Internet $ ________
OTHER INCOME: TRANSPORTATION:
(Financial assistance from family and friends) Car Payment $ ________
$ __________________________________________ Car Insurance $ ________
$ __________________________________________ Gasoline $ ________
$ __________________________________________ Public Transit $ ________
Relief Grant(s) (specify)
MEDICAL/DENTAL:
Health Insurance $ ________
$ __________________________________________ Medical Bills $ ________
$ __________________________________________ Prescriptions $ ________
$ __________________________________________ Dental Bills $ ________
TOTAL INCOME: $ ________ MISCELLANEOUS EXPENSES:
ASSETS: Life Insurance $ ________
Checking Account $ ________ Union Dues $ ________
Savings Account $ ________ Loan(s) $ ________
Other Accounts $ ________ Credit Card(s) $ ________
$ __________________________________________ $ __________________________________________
$ __________________________________________ $ __________________________________________
Real Estate (if applicable) $ __________________________________________
Date Purchased ________ $ __________________________________________
Purchase Price $ ________ Child Support Payments $ ________
Present Value $ ________ Alimony Payments $ ________
Payment $ ________ Laundry/Cleaning $ ________
Are Payments Delinquent? H Yes H No
If yes, how much $ ________ OTHER (list):
In whose name is the property recorded? $ __________________________________________
_____________________________________________ _ $ __________________________________________
TOTAL ASSETS: $ ________ TOTAL EXPENSES: $ ________

4. The applicant’s reason for applying for assistance: ______________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Amount requested: $_____________________________
If applying for financial assistance for medical or dental bills please review and sign the following.
As MusiCares (including its employees and other representatives) deems necessary to review and/or determine my
eligibility to receive financial or medical assistance or other services from MusiCares, I hereby authorize
MusiCares to obtain, and any health care provider (individual or entity, including any type of health care facility or
ancillary provider) to release to MusiCares, any and all information about my health status and any medical
condition. I understand and acknowledge that: a).such information may include, but is not limited to paper and/or
electronic records describing my health history, symptoms, examination and test results, diagnoses, treatment,
and any plans for future care or treatment, and b). such information may include information deemed confidential
under State and/or Federal laws which regulate disclosure of same by a health care provider.
I also agree to reasonably cooperate with MusiCares in its efforts to obtain, and to update as necessary, such
information, and such cooperation shall include executing any additional written consent(s). This authorization
for medical information is valid for one year from the date of my signature below.
Signature of Applicant: ______________________________________________ Date: __________________________
I authorize MusiCares to communicate with the additional parties below to discuss my current situation if needed.
(If requesting rental assistance, please include your landlord.)
Name: ___________________________ Relationship: ___________________ Phone: __________________________
Name: ___________________________ Relationship: ___________________ Phone: __________________________
Name: ___________________________ Relationship: ___________________ Phone: __________________________
Name: ___________________________ Relationship: ___________________ Phone: __________________________
I hereby certify that I have answered the foregoing questions to the best of my ability. The facts herein stated are true
and I understand that any misrepresentation of this information may disqualify me for any assistance from MusiCares.
Signature of Applicant: ______________________________________________ Date: __________________________
To the best of my knowledge, I certify that the above information is true.
Signature of Applicant’s Spouse: _______________________________________Date: __________________________
To the best of my knowledge, I certify that the above information is true.
DATE COMPLETED: ________________________
FOR MORE INFORMATION ON ELIGIBILITY PLEASE GO TO MUSICARES.COM.