SEIU 2015 Wildfire Relief Fund

Eligibility Guidelines

Is a member in good standing.

Available Assistance

Eligible members and their families can receive two types of assistance up to the maximum amount(s):

Housing Assistance: may include cost of temporary housing or repair to existing housing. Maximum assistance amount: $1,000 per SEIU 2015 household
Other Needs Assistance: costs of disaster related expenses and serious needs including medical and dental expenses, funeral and burial costs, repair or replacement of household items such as clothing, furniture, necessary occupational tools and educational materials, costs for clean-up, excess utility costs, and other disaster related expenditures. Maximum assistance amount: $2,000 per SEIU 2015 member.
Members sharing living quarters or otherwise sharing financial responsibility for each other shall be limited to a maximum of $4,000 per household.

Incurred Loss: From the current wildfires

Documentation

Hotel bill
Airbnb rental costs
Grocery receipts
Fast food receipts
Copy of Photo ID
A brief paragraph describing what occurred
1. i.e home burned
2. Told to evacuate by authorities
All the above can be sent via text or e-mail, photos of back up are accepted

Direct Vendor Payments

Vendor contact information if needed, because we may need to make direct payments to a hotel as an example

Cash Advance

Up to $600 cash assistance can be advanced for individuals who reside with the disaster zone. Once purchases have been made with the cash advance, eligible receipts must be submitted equal to or greater than the cash advance amount received. The cash advance amount is included in the maximum award amounts noted above (that is, the combined amount of cash advance, direct vendor payments and reimbursement checks cannot exceed the total award maximum). All documentation should include a name, address, and phone number for the service provider or retailer, who must actually receive payment from you for the service or item. (For example: we cannot reimburse for repairs performed by a neighbor or family member even if they provide you with an “invoice” for the value of the repairs unless you actually paid cash for the service. However, we can reimburse for any equipment, parts or tools which were needed to achieve the repair.)

"*" indicates required fields

SEIU 2015 Wildfire Relief Fund

Your First Name*

Your Last Name*

Cell Phone*

Email*

List the Full Legal Name of Qualifying Member(s): (list everyone in household who may qualify)*

Are you a member in good standing?*

Yes

Current Mailing Address

Mailing Address*

City*

State*

Zip Code*

Did you have a different address at the time of the disaster related loss?*

Yes

Section Break

Former Mailing Address

Mailing Address*

City*

State*

Zip Code*

Section Break – Assistance Block

Type of Assistance Requested*

Temporary housing assistance ($1,000 max)

Other needs reimbursement ($2,000 max)

Section Break

Please describe your other needs reimbursement amount*

Total request ($3,000 max individuals; $4,000 max for 2+ member household)

Other disaster-related loss

Direct vendor payments

Cash advance request

Describe your temporary housing request and the amount $*

Describe your other disaster related loss and the amount $*

Describe what direct vendor payments and the amount $*

Describe your cash advance request and amount $*

Total monetary request ($3,000 max individuals; $4,000 max for 2+ member household)*

Section Break

Document Upload

Please upload formal documentation for all expenses for which you are requesting reimbursement. Staff will contact you via email or phone within 2 business days to confirm receipt of your application. Incomplete or inaccurate applications will not be processed.

Upload File(s)*

Drop files here or

Max. file size: 50 MB.

This field is for validation purposes and should be left unchanged.