CGF Tragedy Assistance Support Request

Tragedy Assistance Support Request

Coast Guard Foundation assistance for Coast Guard members who suffer the loss of a dependent
When Coast Guard families and units face the unthinkable loss of an active-duty member, the Coast Guard Foundation is there with immediate financial and morale support through its tragedy assistance program. We listen closely to individuals and families—and anticipate their needs—to ensure we provide relevant care in the wake of tragedy.

Now, to support active-duty Coast Guard members in their time of great loss, the Coast Guard Foundation has expanded eligibility for the tragedy assistance program to include assistance after the death of a Coast Guard spouse or child.

Active-duty Coast Guard members are eligible to request a $3,000 grant of immediate support in the wake of dependent death to help cover family travel, needs of the surviving family members, and unexpected expenses.

In the event of a multiple deaths in a family from the same incident, Coast Guard Foundation tragedy assistance will provide a $3,000 grant for each dependent loss, up to a maximum of $10,000.

If a Coast Guard member is ineligible to complete the grant request, the request may be completed by a designated family member/guardian/next of kin. In some cases, the assigned CACO or family represenative may complete the form on behalf of the Coast Guard family.

In the event of a total family loss that includes the Coast Guard member and their dependents, Coast Guard Foundation tragedy assistance will include our typical support for a Coast Guard member death, as well as a $3,000 grant for each dependent loss up to a maximum of $10,000. The Coast Guard Foundation will work with the assigned Coast Guard casualty affairs officer to determine to whom the support will be disbursed.

This eligibility expansion covers loss of life only, and does not include injury, sickness, or chronic care for dependents.

Coast Guard members who lose a dependent should complete the support request form on the Foundation website within one year of the loss. The Foundation will confirm eligibility and process the request in a timely manner.

Please direct questions and inquiries to Ms. Sage Williams, Coast Guard Foundation Program Manager: swilliams@coastguardfoundation.org and 860-535-0786.
Coast Guard Member Name:*

PrefixFirst NameLast NameSuffix
Family Representative

First NameLast Name
Address:

Street Address

Apt. #

CityState / Province

Postal / Zip Code
Mailing Address Type:

HomeDuty StationOther
Work E-Mail:
example@example.com
Personal E-Mail:
example@example.com
Preferred Phone Number:

Area CodePhone Number
Alternate/Cell Phone:

Area CodePhone Number
Status of Applicant:

Active DutyReserveOther
Rank/Rate:
E-7,0-3, for example
Current Coast Guard Unit:
Name of cutter, unit, station, etc.
Name of Coast Guard dependent decedent:*

First NameLast Name
Dependent status:*

SpouseChildOther
What are the birth and death dates of dependent?
Proof of eligibility:

Browse Files
Upload a PDF or JPG of the DEERS/MilConnect Service Member profile page with the child or spouse listed as a dependent. Cancelof
Please use this space to detail any additional information re: your support request.
Name of Person Signing/Completing Form
By signing this form requesting support from the Coast Guard Foundation, I hereby declare that the information contained in this application is accurate to the best of my knowledge, and understand that any misstatement of fact may be grounds for denial of this request.

I expressly waive and hold harmless the Coast Guard Foundation and any representative who may be acting on behalf of this fund, from any and all claims that might arise as a result of this application.

I give the Coast Guard Foundation permission to verify the information contained in this support request.

I understand that the Coast Guard Foundation is an independent private entity, not part of the U.S. Government. This application form, therefore, is not subject to the Privacy Act (5 U.S.C. 552a). This form, with attachments, will be kept on file for a period of five (5) years.

I have read, understand and agree to the above requirements for receipt of a monetary grant from the Coast Guard Foundation.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: