Application for Emergency Assistance Grant

Application for Emergency Assistance Grant

National Mass Shooting Victims' Fund
This application is to be used only by immediate family members of the deceased, those wounded/injured, or who have survived a mass casualty crime to request a grant for emergency financial assistance from VictimsFirst's National Mass Shooting Victim's Fund.

This Fund is available to help with the immediate, mid-term, and long-term needs of victims of mass casualty crime. Funds are limited and are dependent upon donations to VictimsFirst.

Information provided will be kept confidential. Applications will be reviewed and processed by our Committee in the order they are received.

If you need assistance filling out this form, please call us at 706-842-8467.
Basic Information
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Valid Photo ID*

Cancelof
Name/Location of Mass Violence Incident (i.e., Robb Elementary School; Uvalde)*
Relationship*
Which emergency assistance grant are you applying for?*

$500.00$1,000.00
Brief Description of the Financial Need*
Documentation of Financial Need

Bill, invoice, lease, notice, etc.
Cancelof
I understand that I can only apply for emergency financial assistance from VictimsFirst once a calendar year.*

YES
Verification Information
Name of Government-Assigned Victim Advocate

First NameLast Name
Phone Number of Victim Advocate
Please enter a valid phone number.
Email of Victim Advocate
example@example.com
Transfer of Funds
If approved, how would you like us to send you the emergency assistance grant?*

ZellePayPalCashAppCheck
Username, Phone, or Email to Locate Account
Please make sure your real name is reflected on your CashApp, Zelle, or PayPal account/profile.
Signature

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Application for Emergency Assistance Grant

Basic Information

Verification Information

Transfer of Funds