Member Relief Request Form

Member Relief Fund Request
Assisting Southwest Montana REALTORS® members suffering financial hardship due to the onset of a major illness, accident, or other unforeseeable life-changing event of the member or the member's immediate family member (spouse, child, parent, sibling, or somebody directly residing with the member). Request maximum amount is $1,000.

For consideration, all fields must be completed.
Who are you submitting this request for?*

MyselfAnother SMR Member

Your Name*

First NameLast Name
Office Name:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your hardship?*
Do you have any other source of household income?*

YesNo
If yes, please explain*
Have you previously received funds from the Southwest Montana REALTORS® Foundation?*

YesNo
Have you ever contributed to the Southwest Montana REALTORS® Foundation?*

YesNo
What is the amount you are requesting?*
Funds will be released only to pay or reimburse applicant for expenses falling into the approved categories of health/ medical, family emergency, and memorial. Funds shall not be used to pay directly any amount due to SMR. Funds released for any applicant will be between $100 minimum and $1,000 maximum per occurrence
Do you agree to help others by our sharing your story*
Should your application be approved, do you give SMRF permission to share your story of how SMRF has helped you? (Your name will be withheld). If you select “yes,” we will contact you for more information and to obtain your approval on what will be shared.

By clicking below and submitting the application, you are affirming the information is true, complete and correct.

All applications are confidential.
Please verify that you are human *
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Member Relief Fund Request