Bereavement Assistance
The Bereavement Assistance Grant honors those lost in the line of duty by providing financial support and the comfort of a community to the family of the fallen hero. This grant awards $5,000 to assist the family with bereavement costs and financial hardship following the loss of their loved one.
PLEASE NOTE:
Only one award per household will be remitted.
FRCF defines first responders as police officers, firefighters, emergency medical technicians/paramedics, and 911 dispatchers/communications. Any other essential workers are not within the mission of our foundation and will, unfortunately, be declined.
The fallen hero should have had children under the age of 18 at end of watch to be eligible.
All information provided on this application will be verified to ensure accuracy and honesty. Falsified statements or documents in any detail will be considered sufficient cause for disqualification. FRCF will report the issue to your employer/supervisor and fraud will be prosecuted to the fullest extent of the law.
FRCF does not and shall not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, or sexual orientation in any of its activities or operations.
Primary Contact
Please provide up-to-date contact information so that we may reach you if we need more information.
Full name
*
First Name
Last Name
Phone number
*
Please enter a valid phone number.
Email
*
Confirmation Email
example@example.com
Preferred method of contact
*
Phone call
Email
Text message
Is the first responder hero a member of your immediate household?
*
Please Select
Yes
No
Your relationship to the fallen
*
First Responder
Please fill out the following, to the best extent you can, about the fallen first responder hero for whom you are applying.
Full name
*
First Name
Last Name
Badge/ID number
*
Agency or affiliation
*
Home address
*
Street Address
Street Address Line 2
City
Please Select
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
State
Zip Code
Kind of first responder
*
Please Select
Emergency medical technician (EMT)
Firefighter
Medical personnel
Police officer
Other position supporting first responders, such as a 911 dispatcher
First responder's work status
*
Please Select
Full-time
Part-time
Volunteer
Please provide a brief job description
*
Hero's end-of-watch
*
-
Month
-
Day
Year
Date
Please describe the circumstances surrounding the line of duty death
*
Supervisor's full name
*
First Name
Last Name
Supervisor's phone number
*
Please enter a valid phone number.
Supervisor's email address
*
example@example.com
Document Uploads
Please note that all submissions will be verified to ensure accuracy and honesty.
First responder's ID badge or proof of employment
Browse Files
Drag and drop files here
Choose a file
If submitting proof of employment, please include it on official letterhead from the affiliated agency
Cancel
of
Funeral bill and other associated expenses
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Certificate of death
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo(s)
Browse Files
Drag and drop files here
Choose a file
Although it is not required, if you would be willing to share photos of your family that includes your first responder hero, please upload them here
Cancel
of
Survey
Please answer a few additional questions about the first responder.
Is the passing of the hero related to COVID-19 complications?
*
Please Select
Yes
No
Have you received assistance from PSBO or any other financial distress program?
*
Please Select
Yes
No
Are you willing to be contacted by a First Responders Children’s Foundation staff member to share your story?
*
Please Select
Yes
No
Gender of first responder
*
Please Select
Male
Female
Other/prefer to self-describe
Hero's age at end-of-watch
*
How many children under 18 did the hero support?
*
What are their ages and genders?
*
If none, just enter N/A
Was the first responder hero a single parent?
*
Please Select
Yes
No
How would you describe the hero's race/ethnicity?
*
Hispanic, Latin, or Spanish origin
American Indian or other Native American
Asian or Pacific Islander
Black or African American
Middle Eastern
White/Caucasian
Other/prefer to self-describe
How did you hear about this program?
*
Please Select
Website
Social media
Referral
Other
Please describe
Submit
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