Fallen Hawk Fund Request Form
Please read the policy and process guide below before completing the application.
Requestor's Name
*
First Name
Last Name
Requestor's Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requestor's Email Address
*
example@example.com
Requestor's Affiliation:
*
Please Select
Financial Member of the Chapter
Alumni
Family of Alumnus
Family of UMES Student
Type of Support (Full details available in the policy above):
*
Please Select
Option 1: Funeral Tribute (floral arrangements, sympathy cards or chapter wreath - Max: $200.00)
Option 2: Repast Support (food or venue costs - Max: $200.00)
Option 3: Additional Services (streaming, officiant honorarium, church rental, or memorial program - Max: $250.00)
Option 4: Bereavement Acknowledgment (sympathy card, floral tribute, or memorial acknowledgment for death of an alumni's extended relative - Max $75.00)
Total requested ($):
*
Maximum limits apply.
Urgent request?
*
Yes
No
Address for flowers, cards, etc.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Documentation
*
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