Check: if you are submitting this application on behalf of another member who has an emergency:I have the consent of this applicant to submit this request for emergency relief on his/her behalf. (enter your name and phone number in the box below)Name *Phone *Enter Personal InformationFirst Name *Last Name *Phone Number *Email Address *Explain the EmergencyBrief summary of the circumstances *0 / 180Upload fileChoose FileNo file chosenDelete uploaded fileEnter Debt-holder or Business InformationProvide information relating to the debt-holders or business pertinent to each emergency case that you have, to include contact information and amount needed to pay each debt-holder or business.1st. Emergency caseDebt holder/business Name 1 *Amount to be paid 1 *USDStreet Address 1 *City *State/Province *ZIP / Postal Code *Email Address 1 *Phone 1 *0 / 102nd. Emergency caseDebt-holder/Business Name 2Amount to be paid 2USDStreet Address 2CityState/ProvinceZIP / Postal CodeEmail Address 2Phone 23rd. Emergency caseDebt-holder/Business Name 3Amount to be paid 3USDStreet Address 3CityState/ProvinceZIP / Postal CodeEmail Address 3Phone 3Total Amount needed to relieve the emergency:Total Amount CalculationRead Ford Family Emergency Relief Program The purpose of the Ford Family Emergency Relief Program (FFERP) is to establish a standard procedure for requesting, funding, and providing emergency relief to members who are faced with an urgent financial need, resulting from unforeseen or unavoidable circumstances. Eligibility: Any family member who is faced with an urgent finical need that exceeds his/her means to handle, may apply for relief under the provisions of this program. Applications: members who wish to apply for emergency relief under this program must complete and submit this application which includes: (1) a brief summary of the circumstances causing the emergency and (2) a list of debt-holders or businesses pertinent to the emergency; including the contact information and amount needed to pay each debt-holder or business. Funding: will be raised similar to the way “Go Fund Me” programs operates. Family members will be asked to donate voluntarily on a case-by-case basis. Funds raised for a particular emergency case will be used for emergency cases exclusively. Donations: generally, donations will be made online into the “Family Emergency Relief Funds” account that is linked to the Ford Family website, www.ford-family.info. Donations are tax-deductible, in accordance with IRC Section 501 (c) (13) under FFH&WA. Accountability: the provisions of this program are mindful of the delicate balance between preserving the personal respect of members who needs assistance and safeguarding the trust and generosity of those who donate to it. Therefore, to the extent possible this program will: (1) preserve the dignity of all members who seeks relief under its provisions, and (2) will safeguard the integrity of the program by requiring a high level of accountability that is worthy of the trust and generosity of donors and supporters. Disbursements: generally, payments will be made directly to the debt-holder of bills owed, or to the business for the cost of goods or services needed by the member who is granted emergency relief under this program. Administrative process: The President of FFH&WA or the FFERP co-managers on the Board of Directors will review the application for all required information. If the application contains all required information it will be forwarded via group email to family members to request donations to fund the emergency. Otherwise, the applicant will be asked to provide the missing or incomplete information. Note: Under this program, a third party may request emergency relief on behalf of another member who needs assistance; but only with the consent of the member needing the assistance.I have read and agree with the eligibility requirement, administrative process and accountability provisions concerning of this application: *YesNoSubmit
