Assistance Request Form for Austin Fire Auxiliary

Assistance Request Form for Austin Fire Auxiliary

The Auxiliary to Austin Fire is dedicated to supporting the hearts behind our heroes. If you or a member of the Austin Fire Department family is facing a hardship, injury, illness, or other crisis, please fill out this form. All requests are kept strictly confidential and will be reviewed by our board as quickly as possible.
*Important Notice: Please note that the Auxiliary to Austin Fire cannot provide direct financial assistance. However, we are fully committed to supporting our AFD family through hardships by providing meals, snacks for the family, specialized medical equipment, or other tangible items and services to help ease your burden during difficult times. Please do not hesitate to reach out—if you contact us, we will do our absolute best to figure out a way to help.
Section 1: Applicant Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Best Time/Method to Contact You
Your Affiliation with Austin Fire

Other
(If Applicable) Station/Shift/Rank/Position
Section 2: Recipient Information
Recipient Information - are you requesting assistance for yourself or on behalf of someone else?

Other
Recipient Name:
Recipient Station/Shift:
Does the recipient know you are requesting assistance on their behalf?

Other
Section 3: Assistance Details
Type of Assistance Needed (Check All that Apply)

Other
Please provide a brief description of the situation and how we can help:(Share as much or as little detail as you feel comfortable with, just enough so our team understands the need.)
Is This an Urgent Request?

Other
Section 4: Acknowledgment & Submission

By submitting this form, you acknowledge that the Auxiliary to Austin Fire will review this request and contact you to discuss how we can best support the need through donated goods, meals, or equipment. While we strive to help whenever possible, assistance is based on available resources.
Signature
Date

MonthDayYear
Date
Should be Empty:

Assistance Request Form for Austin Fire Auxiliary

Section 1: Applicant Information

Section 2: Recipient Information

Section 3: Assistance Details

Section 4: Acknowledgment & Submission