USFA Convention Grant Application Form

Utah State Firefighters' Association

Organized September 16, 1908 Incorporated August 17, 1910
USFA CONVENTION GRANT APPLICATION FORM

Contact: Secretary Gina Bell @ secretaryusfa2@gmail.com
Name of Member

First NameLast Name
Applicant Fire Department
Have you received this grant in the past and if so, what year?
Yes/No and Year
Lifetime member? If yes, what year did you become one?
Yes/No
Have you attended a previous convention and if so what year?
Yes/No and Year
Are you receiving an award?

Yes/NoHow Many Years
Does your department receive funding from the municipality you service to send members to convention?
Yes/No
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Please tell us why you should be selected to receive a $250.00 grant to attend convention. Deadline is April 1st of the convention year.
YOU WILL BE NOTIFIED BY EMAIL IF YOUR GRANT IS APPROVED. ONCE APPROVED YOU WILL NEED TO SUBMIT RECEIPTS TO BE REIMBURSED.
Attach Scanned Receipts for Reimbursement up to $250.00

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Utah State Firefighters' Association