CSFFF Assistance Grant Form

Application Details
If the recipient is not a firefighter, what is the individual's family relationship to the firefighter?
Applications may be submitted by individuals other than the intended recipient if the applicant has relevant knowledge (e.g., by a Fire Department on behalf of one of its firefighters), if determined by the CSFFF to be appropriate under the circumstances. If the applicant is not the recipient, what is your relationship to the recipient?
Amount of Assistance Requested*
Purpose of Funds & Personal Statement of Reason for Assistance.*
Have you applied and/or received assistance before?*

YesNo
Please describe any other relevant information or circumstances:

Disclaimers
By submitting this application , I certify that all of the information that I have provided to the CSFFF, and in connection with, this application is true, correct and complete, to the best of my knowledge. With this submission I authorize the CSFFF to request any type of credit/background reports that is needed to process this application request.
I understand that:

1. The Colorado State Fire Fighters Foundation is a Section 501(c)(3) tax- exempt non profit corporation, and is subject to the various legal requirements in awarding assistance under the Firefighter Assistance Program. All assistance will be made in accordance with the Guidelines of the Colorado State Fire Fighters Foundation and applicable law.

2. Additional information and documentation may be required (1) in order to qualify for assistance, and/or (2) after assistance is make, to confirm that the funds were used by the intended recipient. The Colorado State Fire Fighters Foundation will determine in its sole discretion whether the documentation provided is sufficient.

3. The Colorado State Fire Fighters Foundation seeks to support firefighters and families who are eligible for assistance under the Colorado State Fire Fighters Foundation Assistance Guidelines. However, eligibility for assistance does not guarantee that assistance will be awarded. All assistance will be made by the Colorado State Fire Fighters Foundation in its sole discretion.
Signature*
Should be Empty:

Application Details