Individual Request for Grant

We Are Here to Help!

Please let us know if you become aware of a catastrophic event where an individual needs our help and meets the mission of the Rob Benzon Dan Ferbal Foundation.

Simply have the party complete applications below, so that our Board can continue with our philanthropic mission of providing unexpected help and hope to those in need.

    For Person Submitting This Form:

    Full Name:*

    Email:*

    Company or business:

    Address:

    City:

    State:

    Zip:

    Phone:

    For Grant Recipient (if different from above):

    Full Name:

    Email:

    Company or business:

    Address:

    City:

    State:

    Zip:

    Phone:

     

    How did you hear about the Rob Benzon Foundation:

    Provide a detailed statement describing the need to be addressed. Please be thorough - the response to these questions are the basis for evaluation by the board. Please be sure to include when the incident/accident occurred, what has happened since and, where applicable, the prognosis and/or plan for the future.

    Have other donations been requested/approved from other charitable organizations?

    yesno

    If so, which organizations? In not, why not?

    What other sources for funds have been considered/attempted (ie. Insurance Disability, sick leave, unemployment)?

    Is the applicant insured? If not, is the applicant’s occupation one in which insurance is not available?

    Donation amount requested and how you arrived at this figure?

    How will the donation be used?

    Are there invoices, bills, or receipts for expenses that could be reimbursed in lieu of a check made to an individual? If so, please provide more detail.

    Are you familiar with the Rob Benzon Foundation and have you read the mission statement and “about” pages of the website www.robbenzondanferbal.org?

    yesno