Fillable Fire-relief-application Ekho My Heart - Thomas Relief Fund HR.pub

Fill Online, Printable, Fillable, Blank Fire-relief-application Ekho My Heart - Thomas Relief Fund HR.pub Form

Use Fill to complete blank online CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Fire-relief-application Ekho My Heart - Thomas Relief Fund HR.pub

On average this form takes 6 minutes to complete

The Fire-relief-application Ekho My Heart - Thomas Relief Fund HR.pub form is 2 pages long and contains:

  • 1 signature
  • 4 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University Channel Islands

BROWSE CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Ekho Your Heart
FIRE RELIEF FUND APPLICATION
DECEMBER, 2017
A special fire relief fund has been established under the Ekho Your Heart Program to assist CSUCI students, staff, and faculty re-
covering from the December 2017 fires that destroyed homes and displaced people throughout Ventura, Santa Barbara and Los
Angeles Counties. This fund has been established to help provide basic necessities to those with the greatest need.
APPLICATION PROCESS
1. Complete the Application Form with appropriate explanation and supporting documentation.
2. Print, sign and deliver to Human Resources, Lindero Hall, Room 1804.
OR Print, sign, scan and email to HRServices@csuci.edu or fax to 805-437-8491
WHO’S ELIGIBLE
Applicants must be current CSUCI student, staff, or faculty and be able to document a short-term financial hardship resulting from
the December 2017 fires. This fund is not intended to cover expenses otherwise covered by an applicant’s insurance.
POTENTIAL AWARD AMOUNT
Awards will be granted on a case-by-case basis up to $1,000. Awards may be subject to income tax.
SELECTION
The Ekho Your Heart Fire Relief Fund Committee will meet weekly to review applications and recommend to the President those
selected to receive funding.
Funds are limited and will be awarded in the order in which applications are received. All information pertaining to this applica-
tion and subsequent award will be confidential to the extent allowed by law.
Questions may be directed to Human Resources at HRServices@csuci.edu, Lindero Hall 1804, or 805-437-8490.
Internal Use: Employee __ yes __ no Approved __ yes __ no Award Amount: ________
EKHO YOUR HEART FIRE RELIEF FUND APPLICATION
Please check one and complete ALL information in fields below.
Student Faculty Staff
LAST Name _______________________________ FIRST Name ______________________________ Middle Initial _______
Student/Staff/Faculty ID Number __________________________
Current Mailing Address _________________________________________________________________________________
City ___________________________________________________________ State __
________ Zip ___________________
Email _______________________________________________________ Telephone _______________________________
Amount Requested __________________________________________________
Please provide det
ailed answers to the questions below. Attach additional documentation if needed.
1. In what way did the fire affect you (check all that apply)?
Primary residence was destroyed or significantly damaged
Lost personal belongings
Incurred temporary expenses related to evacuation
Other
Please explain further in box below.
2. How will these f
unds assist you in meeting your needs?
I, the undersigned, certify that the information provided on this application is true and that the amount requested under this
application is not covered by other insurance coverage.
Application Signature ___________________________________________________________ Date _______________________
Application Name (print) _____________________________________________________________________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Fire-relief-application Ekho My Heart - Thomas Relief Fund HR.pub

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document