Request Funds

Recipient Full Name and Full Name of Person Making Request (if different than recipient)

Contact Phone Number

Recipient Phone Number (If different than above)

Recipient aware of this request?

Recipent Address

What CFD committee is the recipient a member of and how long has the recipient been a CFD volunteer?

Why is assistance being requested? (Please provide as much detail as possible as to the situation that caused the need for assistance)

Medical?

Bills (Mortgage, Utilities, Etc)?

Funeral Expenses?

Other?

Total amount of assistance being requested

What resources are currently available to the potential recipient? (Savings, Insurance, Investments, other sources of resources/funds available, etc)

Thank you for submitting the request for a donation.