Legal Consultation Grant Application

Legal Consultation Grant Application

Designed to assist members with potential legal issues involving Employment Related Practices Liability, Harassment/Bullying, or other issues needing legal assistance before they result in claims or suits. Multi-Line Program approved counsel must be utilized with this grant.
Member Name (SU/SD)
Applicant Name:
Applicant Title:
Email:

Confirmation Emailexample@example.com
Phone #:
Please enter a valid phone numberFormat: (000) 000-0000.
Multi-Line Program approved counsel must be utilized with this grant.

Grant Amount: $2,500 maximum per member per fiscal year

Be sure to review the VSBIT Grants Page for additional information!

Please forward any additional documentation (if available)
Requested Grant Amount: (max: $2,500)
Reason for requesting grant:
Briefly describe the incident that prompted this request?
Have you sought legal counsel for this issue previously?
Please provide information for legal counsel
Invoice/Estimate Upload. VSBIT requires the use of Lynn, Lynn, Blackman, and Toohey (LLBT) for this to be approved. Invoices from other law firms may not be approved.

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Additional Document(s)

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Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business Manager or Superintendent Signature:
Business Manager or Superintendent Printed Name:
Should be Empty: