Request for Assiatnce from the VFF Benevolent Fund

Request for Assistance from the Ventura Fire Foundation Benevolent Fund

The Ventura Fire Foundation Benevolent Fund provides assistance to individuals who, because of a natural disaster, an act of terrorism, job-related injury, or other personal tragedy, have a financial need and are an appropriate recipient of assistance from a charity.

Eligibility and award. Active or retired California firefighters, and their immediate family members (spouses or domestic partners, children/step-children, and parents/step-parents), who reside in the United States. The maximum possible grant per application is $5,000.

Personal Information

I am submitting this form *

For myself, I am an active or retired California firefighter.

For myself, I am the immediate family member of an active or retired California firefighter.

On behalf of an active or retired California firefighter.

My first name *

My last name *

My phone *

My email *

My relationship to California firefighter *

My street *

My city *

My state *

My zip *

Firefighter's Dept. (name and city) *

The firefighter is *

Active

Retired

If you are the firefighter completing this form for yourself, please ignore the following questions:

Firefighter's first name

Firefighter's last name

Firefighter's phone

Firefighter's email

Request Details

Amount requested *

Describe the need for this request. Be as detailed as possible. *

Additional information

The Foundation prefers to pay bills directly, not to issue checks to individuals. Please list who we should pay and how (electronically, credit card, mail a check, etc)., including the mailing address and other contact information. *

Please email supporting documentation (bills, receipts, statements, etc.) to Joe Booth at Joe@venturafirefoundation.org. Requests will not be considered until documentation is received.

I will email my documentation. *

Yes

Deliberation Release

The Board is unable to consider anonymous requests. Therefore, they must know the name(s) of potential recipients of Foundation support, even if Board members are otherwise bound by confidentiality due to their role in the Department. Regardless, deliberations within the Board are confidential, unless you authorize us publicize the support via the Publicity Release below.

Select one *

VFF Board members may use my name/recipient's name in their confidential deliberations.

VFF MAY NOT use my name/recipient's name in their confidential deliberations (selecting this option means the Board will not consider your request).

Publicity Release

In order to encourage more firefighters to request support, and to receive additional donations, the Ventura Fire Foundation publicizes our grantmaking. Information we may publicize includes the firefighter's name, rank, department, active/retired status, grant amount, and for family, the grant recipient's relationship to the firefighter.

Information is only publicized if the request is approved.

However, we understand that individuals may not want their name publicized and will respect their wishes.

Examples of how we might publicize the information include:

Engineer John Smith, Ventura City Fire, $5,000

Firefighter Steven Jones (ret.), Oxnard Fire, $2,000

Sarah Chen, widow of Ventura County Firefighter Joe Chen, $3,000

Anonymous firefighter, Ventura City Fire, $5,000

Anonymous, child of Fillmore firefighter (ret.), $2,000

Select one *

VFF may publicize all individuals' names associated with the grant.

VFF may NOT publicize any individuals' names associated with the grant.

Verification

I attest that the information in this request is true and accurate.

Name *

Date *