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.
MorningAfternoonEveningCallTextEmail
AFD Firefighter (Active)AFD Firefighter (Retired)SpouseFamily Member of AFD PersonnelAFD Civilian StaffOther
(If Applicable) Station/Shift/Rank/Position
Section 2: Recipient Information
For myself/my immediate familyOn behalf of a co-worker/friendOther
Recipient Name:
Recipient Station/Shift:
YesNoOther
Section 3: Assistance Details
Meal Train / Food Delivery / GroceriesMedical Equipment DonationLodging / Transportation AssistanceCoordinating Home or Hospital VisitsBereavement SupportOther
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.)*
Yes, immediate assistance is needed (within 24-48 hours)No, but assistance is needed soonOngoing / Long-term support neededOther
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