The first step in requesting financial assistance from the BCF is to read the program guidelines. If you feel your request falls within the guidelines, complete and return this confidential application. Directions about how to send in this form are at the end of the application. Once received, the Human Resources Department will contact you within two business days.
If your employment status meets initial eligibility guidelines, we will review the information you provide in response to thefollowing questions - including personal information, financial data and details about the specific event that is triggering this request - to make a determination on your BCF application. This information will be kept confidential and will not be usedfor any purpose other than in conjunction with this application for BCF benefits.
REQUIRED - Provide supporting documentation when applicable. Documentation may include but is not limited to:
If not, please detail other sources and income as follows:
I represent and acknowledge that the above information is true and accurate to the best of my knowledge and has been provided in conjunction with my application for BCF benefits. I understand the BCF Guidelines and I also understand that the allocation of BCFs is determined by priority of the situation, the availability of funds and the sole discretion of the BCF staff.
The Human Resources Department will contact you within two business days of receiving the application for further information. If you have questions, please email bluemontcares@bluemontgroup.net.