SUAA Foundation Emergency Assistance Questionnaire
All information will be kept confidential.
Chapter Name
Chapter President
First Name
Last Name
Contact Person
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Member Needing Assistance
*
Member Name
Street Address
City
State / Province
Postal / Zip Code
Member Phone Number
*
-
Area Code
Phone Number
Member E-mail
*
Summary of emergency situation:
Amount $ Requested
Amount Contributed by Chapter
Have Individuals been contacted for donations?
Yes
No
If so, how much has been collected?
How will the money be spent?
Are Chapter members making non-cash donations? If so, in what form?
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