Application for Emergency Assistance

State

Argentum?

Completed Heroes Survey?

Happy Feet?

Applicant Information

Employee Name

Email Address

Cell Phone

Day with CO

Emergency assistance was last Awarded on:

Was EA Last award with in the last 12 months

Employee ID

What is your total household income?

Total Annual Household Income is the combined income of all individuals residing in a household from all sources over a 12-month period, calculated prior to taxes and deductions. This includes earnings from employment, self-employment, retirement benefits, investments, government assistance, and any other consistent sources of income.

How many dependent children in the house?

Marital Status?

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

Eligibility

You are not eligible for emergency assistance at this time because you have already received funds within the last 12 months.

Exceptions may apply for:

Documented domestic violence situations
Catastrophic loss of property due to natural disasters or house fire

If you believe you qualify for an exception, supporting documentation will be required. Please use the drop down menu to apply for the above exceptions.

Eligibility

At this time you are not eligible for the emergency assistance program. The Foundation requires all eligible employees to complete at least 90 days of employment before applying to the emergency assistance program. Please visit https://thetrilogyfoundation.org/emergency-assistance/ for more information.

Reason for Support

Food Assistance

Due to high demand of food assistance requests, the Foundation is prioritizing SNAP-eligible employees only. The amount awarded will be based on household size, with a maximum amount of $200. For documentation, employees must upload proof of SNAP eligibility to receive funds.

Amount Requested

EA Details

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 proper documentation for all requests. Acceptable documentation is generally in the form of a past-due bill, estimate from a company, shut-off/eviction notice, or something else of this nature. Please keep in mind all documentation must include the employee’s name and address, and show a financial need. Screenshots and other forms of documentation that do not show a financial need will be denied.

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