ESP International Charitable Foundation

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Catastrophic or Extreme Circumstances

The ESP International Charitable Foundation may help employees who are unable to pay for housing, utilities, food, clothing and other basic living expenses because of a sudden condition or catastrophe beyond the employee's control. This may be a house fire, serious crime against the employee or eligible dependant such as violet domestic abuse, or another reported incident that the employee could not avoid or prevent. Catastrophic or extreme circumstances do not include credit card bills, home foreclosures, car repair, or accumulated financial distress

 

What's Covered:

 

• Medical expenses (not eligible for reimbursement by insurance)
• Temporary housing
• Security deposit for new rental property
• Essential utility bills (electricity, heat, water, etc)
• Limited, short-term car rental
• Basic living expenses such as food and clothing

 

What's Not Covered:

 

• Credit card, auto and other debts
• Non-essential utilities (cable, phone, etc.)
• Lost wages Auto repairs or replacement
• Furniture, appliances, electronics Insurance deductibles or insured property losses
• Property repair, rebuilding

 

Assistance Application/Vendors to be Paid

Date of Event*

Described what has happened to the employee. Include any information that would help us assess this application

Is there insurance that would help in this situation

 Yes

 No

Describe in detail the employee’s immediate needs

How will this grant help the employee recover from the immediate financial crisis

Please tell us anything else that would help us understand the circumstances related to the economic hardship you are experiencing

Submitted by*

Vendor Name and Address*

Basic need provided through service*

Amount Owed*

Date Payment Due*

Account Number*

Vendor Name and Address - 2

Basic need provided through service - 2

Amount Owed - 2

Date payment due - 2

Account Number - 2

Vendor Name and Address - 3

Basic need provided through service - 3

Amount owed - 3

Date payment due - 3

Account Number - 3

Email Address - Who submitted* Send me a copy of form

Please confirm that you are not a script by entering the letters from the image.

Important: A police or fire report or other related documents regarding the situation must be submitted with this application

Document Checklist: (These need to be completed before application is considered)

___ Assistance Application

___ Incident Report

___ List of vendors to be paid

___ Additional documentation as requested

 

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