To fill out this form you will need - 2 months of bank statements, your last 2 pay stubs, all invoices or bills requesting to be paid. If this is for a death of an immediate family member, the W-9 and letter of statement or funeral expense invoice is needed.

Personal Information

First Name

Last Name

Primary Phone

Who is your Internal SHC contact

How many children under 18 are in your household

Other

Address

City

State

Postal Code

How did you hear about the SHC Compassion Fund

Who told you about the Compassion Fund

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 Assistance Information

Reason for Support (Required)

Is Money owed to a company?

Company Address

Company Phone Number

Funeral Home Name

Funeral Home Address

Funeral Home Phone Number

Funeral Home IEN

	Monies Owed to - ex. ABC Rental Company	Explanation of Help Requested - ex. Rent	Amount Requested - Actual $$ Amount

Total Amount Requested

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

Date last award received

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, will result in a decreased chance of your request being funded.

File Uploads needed

Last 2 months bank statements (Required)

Last 2 pay stubs (Required)

Invoices/bills (Required)

All other incidental documentation - if request is for Death of Immediate Family Member - W-9 and Letter of Statement or Funeral Expense Invoice is needed

The Compassion Fund 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