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 *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
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. *
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 *