You are now beginning an application for benefits for the Roundy's Oconomowoc Victims & Survivors' Fund. You may choose Save at any time to finish the application later, but you must finish this application by hitting the “SUBMIT” button on the final page by 11:59 PM on August 6, 2021. If you do not see a screen confirmation message and receive an e-mail message confirming that you have completed the application, you have not formally submitted the application and are not yet eligible for benefits.
Fields marked with a * are required. "Applicant" refers to the person completing this application. "Victim" refers to the person who any individuals who were physically present in the Oconomowoc Distribution Center at the time of the shooting and experienced psychological trauma as a result are eligible to receive payment under this protocol. "Representative" refers to the legal representative of the victim.
The rules for how these funds are to be distributed is governed by the FINAL PROTOCOL which is available online at: