Employee Relief and Assistance Application

Coeurs d’Acadian, French for The Hearts of Acadian, is the philanthropic core of Acadian Companies, which beats strong within the communities where our employee-owners work and serve. Our vision is to be a source of support and relief for our employees and community members in need by providing training, resources, employment opportunities, and assistance.

 

IMPORTANT: Please review this entire page before beginning the application, as there is specific supporting documentation you will need to gather and complete in order to submit your application. You are able to save your application progress and return to complete it as needed.

Purpose of the Fund

To provide short-term financial assistance to Acadian Companies employees who experience financial hardship due to an emergency situation that is beyond their control.

 

Eligibility Requirements

Eligible recipient is on a per household basis that, at the time of the emergency situation, there resided at least one active employee meeting the following criteria:

• Full time employee
• Part time employee who in the thirty days prior to the emergency situation met the minimum hourly requirements; or
• Active employee who meets one of the above criteria or would meet the above criteria but for that employees placement on Worker's Compensation (absent due to a qualifying and approved FMLA event or placement on disability based upon a qualifying ADA event)

 

Details on Application Process

In an effort to assist as many employees as possible, the following limitations shall apply to the Fund:

• Employees shall be allowed to apply to the fund once every 18 months.
• Maximum grant is $1,000 per event per household and will depend on the level of contributions to the fund.
• Any employee who reaches a total of $5,000 may be ineligible for future grants from the fund.
• Only qualifying events that have occurred within the past 90 days will be considered.
• Grants are completely tax-free under IRS Section 139 and do not need to be repaid.

 

Application Approval Process Timeframe

You can save your form progress and return later to complete it.

1. Upon submission, you will be notified of receipt of the application by the Foundation Director.
2. Once it is determined that your application is complete and all necessary supporting documentation is submitted, the Foundation Director will assign a random case number and forward the application (without any personal identifying information) to the Distribution Committee.
3. The Distribution Committee will review your application (without any personal identifying information) and will either approve or reject the application with supporting explanation.
   • For natural disasters or household fire applications, Coeurs d'Acadian reserves the right to have a representative verify damages in person for extreme circumstances but it will be confidential, and the distribution committee is not involved.
4. Pending the receipt of complete documentation, a decision will be made by the Coeurs d’Acadian Distribution Committee on the application within 3 weeks.
   • If approved, per your request in the application, a check will either be cut and mailed to the designated address or will be sent via direct deposit.
   • If your application is denied, you will receive a formal letter explaining the reason for the denial.

 

Needs Covered by the Fund

Natural Disasters

The foundation can help employees who have been impacted by natural disasters such as a hurricane, flood, wildfire, lightning, tornado, earthquake, or ice/winter storm. Only qualifying events that have occurred within the past 90 days will be considered.

• Homeowners: urgent house repairs
• Renters: rental cost assistance
• Loss of food, clothing, or personal belongings
• Short-term lodging alternatives, if residence is uninhabitable
• Critical medical expenses/medical care not covered by insurance

Required Documentation

You must certify you have an immediate need for food, clothing, or shelter. Provide proof of damage resulting from the disaster (photos, repair estimates, insurance reports, etc.) Provide proof of home ownership or rental (utility bill, phone bill, rental agreement, etc.)  You must complete the Property Information portion of the application to be considered for approval.

 

Household Fire

The foundation can help employees who have been impacted by a residential fire that makes the residence uninhabitable. Only qualifying events that have occurred within the past 90 days will be considered.

• Homeowners: urgent house repairs
• Renters: rental cost assistance
• Loss of food, clothing, or personal belongings
• Short-term lodging alternatives, if residence is uninhabitable
• Critical medical expenses/medical care not covered by insurance

Required Documentation

You must certify you have an immediate need for food, clothing, or shelter. Provide a copy of the fire report. Provide proof of home ownership or rental (utility bill, phone bill, rental agreement, etc.) You must complete the Property Information portion of the application to be considered for approval.

 

Life-threatening critical illness or injury

(Acadian employee or immediate family member, as defined below and in the physician attestation)

• Grants to assist with financial hardship incurred as a life-threatening result of critical illness or injury to you or your immediate family (spouse, domestic partner, dependent children, dependent stepchildren, or dependent children of whom the employee has parental responsibility.) Only qualifying events that have occurred within the past 90 days will be considered.
• Coeurs d’Acadian can help employees who have an extended illness or injury to themselves or within their immediate family, which requires absence from work and/or excessive medical costs resulting in a critical economic hardship. Coeurs d’Acadian does not reimburse for medical bills or premiums, but does help pay for essential living expenses such as rent/mortgage, utilities, and food when a medical condition has resulted in a loss of income.
• Critical illness or injury is defined as a life-threatening medical condition which requires a person to be under the active care and treatment by a physician, including periodic visits for treatment that continue over an extended period of time and may cause episodic incapacity (inability to work or perform other regular daily duties due to the serious health condition) e.g. heart attack, stroke, cancer, end-stage renal disease, major third-degree burns, or paralysis.
• A dependent is defined as being under the age of 26 unless incapable of self-care because of mental or physical disability or as a result of chronic addiction.

Required Documentation

Must complete and submit the physician’s attestation, and must certify you have an immediate need for financial assistance by supplying additional supporting documentation to substantiate such need.

Documents containing personal health information will not be shared with the Distribution Committee in order to protect confidentiality.

 

Death of an Acadian employee or immediate family member

(as defined below)

• Grants to assist with funeral expenses will be considered when there is unexpected financial hardship. Only extenuating circumstances that have occurred within the past 90 days will be considered.
• Immediate family members are defined as the employee’s spouse, domestic partner, dependent children, dependent stepchildren, or dependent children of whom the employee has parental responsibility.
• A dependent is defined as being under the age of 26 unless incapable of self-care because of mental or physical disability or as a result of chronic addiction.

Required Documentation

• Detailed explanation of the financial hardship resulting from the death, and the need for assistance.
• Proof of death in the form of funeral home documentation or a published obituary from a newspaper stating the date of death as well as the applicant’s relationship to the deceased.

Documents containing identifiable information will not be shared with the Distribution Committee in order to protect confidentiality.

 

Form Downloads

If applicable to your application, please download and complete these forms. You will need to upload the completed forms with your application, along with other supporting documentation if required.

• Physician Attestation Form
• Direct Deposit Authorization Form

 

Contact

If you have questions regarding application completion, please send an email to relief@coeurs.org.

This page will not be included in the application packet sent to the Distribution Committee.

Only qualifying events that have occurred within the past 90 days will be eligible for assistance.

Required documentation: Must complete and submit the physician’s attestation, and must certify you have an immediate need for financial assistance by supplying additional supporting documentation to substantiate such need.

Documents containing personal health information will not be shared with the Distribution Committee in order to protect confidentiality.

Download the Physician Attestation Form.

Required documentation: 

• Detailed explanation of the financial hardship resulting from the death, and the need for assistance.
• Proof of death in the form of funeral home documentation or a published obituary from a newspaper stating the date of death as well as the applicant’s relationship to the deceased.

Documents containing identifiable information will not be shared with the Distribution Committee in order to protect confidentiality.

Immediate family members are defined as the employee’s spouse, domestic partner, dependent children, dependent stepchildren, or dependent children of whom the employee has parental responsibility.

A dependent is defined as being under the age of 26 unless incapable of self-care because of mental or physical disability or as a result of chronic addiction.

Natural disaster required documentation: You must certify you have an immediate need for food, clothing, or shelter. Provide proof of damage resulting from the disaster (photos, repair estimates, insurance reports, etc.) Provide proof of home ownership or rental (utility bill, phone bill, rental agreement, etc.) You must complete the Property Information portion of the application to be considered for approval.

 

Household Fire required documentation: Must certify you have an immediate need for food, clothing, or shelter. Provide a copy of the fire report. Provide proof of home ownership or rental (utility bill, phone bill, rental agreement, etc.) You must complete the Property Information portion of the application to be considered for approval.

I understand that no employee is entitled to receive a grant, either by their employment, their history of contributions to Coeurs d’Acadian or because of any precedent inferred from a previous grant from Coeurs d’Acadian.

I understand further that this application will be treated in a confidential manner by Coeurs d’Acadian; however, program information will be reported to Acadian Companies on a periodic basis.

Employees are expected to provide truthful and accurate information. In its due diligence, if Coeurs d’Acadian discovers any information in this application to be materially untrue or fraudulent, I recognize that I may no longer expect this application to be treated confidentially.

My signature below certifies that the information provided is true and complete, authorizes Coeurs d’Acadian to obtain and/or verify all information necessary to process this application, and releases Acadian Companies and Coeurs d’Acadian from any liability associated with the rejection of or funding of this application. In addition, I hereby agree to provide any requested documentation supporting the information provided.

Upon submission, your full application will be sent to the Foundation Director to ensure all necessary supporting documentation is submitted. Once determined that your application is complete, the Distribution Committee will receive your information with a random case number; your name, employee number, address, phone number, position/title will NOT be revealed to the Distribution Committee.