Application for Emergency Assistance

Applicant Information

Employee Name

Email Address

Cell Phone

Employee SSN

For Employee SSN: The - symbol must be used between the groups of numbers. E.g. 111-11-1111. Error 1.1 would signify an invalid SSN or invalid formatting.

You will be notified of your Emergency Assistance application status by email. Please verify that you have provided valid contact information. You will only receive communication concerning your application.

Emergency Information

Reason for Support

Amount Requested

$200 is the max for Campus Funds

Amount Requested

$1000 is the max for Foundation Funds

Have you received an emergency assistance award within the last 12 months?

YesNo

Please provide a detailed explanation for your request including details of both the cause(s) and effect(s) of your emergency. Lack of detail, and documentation if requested by your Executive Director, will result in a decreased chance of your request being funded.

Documentation

In order to be good stewards of the donations that are provided to us we require verification of an emergency in most situations. This verification is generally in the form of a payment receipt, an estimate from a company, or something else of this nature.

If you are able to upload this documentation here it may be able to greatly increase the speed in which the Foundation can make a final decision on the request.

Documentation Upload 1

Documentation Upload 2

Documentation

Documentation Upload 1

Documentation Upload 2

The Trilogy Foundation seeks to provide support to employees in times of catastrophic events. A committee will review all requests for assistance. Awards are determined on a case-by-case basis and the amount of your assistance may not equal the amount you have requested. Depending on the situation, you may be asked to provide documentation that supports the details of your emergency.

Contact Information