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Brett's First Responders Financial Assistance Application 
Family Need Eligibility Requirements and Application

Support for First Responders and their families in times of need.

Thank you for your interest in Brett’s First Responders Family Need Program. Our Program is restricted to the following:
First Responder (firefighter, police, EMT) is deceased, seriously injured, or suffering from a significant illness within the last 12 months/1 year unrelated to their career as a first responder.
First Responder is survived by a parent, spouse, child or children.
At least one of the surviving children is 18 years of age or younger.
Surviving family has a demonstrated financial need.
Surviving parent of the First Responder’s child(ren) is not re-married, engaged, or currently
cohabiting.
If First Responder and surviving parent were married, they cannot have been divorced at time of
death.

First responder is defined as fire fighter, police, or paramedic in our by laws.

If you fulfill all of the eligibility requirements, your application will be vetted and reviewed by our team, and you will be notified of a decision. Please note that meeting our eligibility requirements does not automatically guarantee acceptance to our Program.

Please complete and submit the information below. Note: All responses are confidential and will only be shared among our selection committee.
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Email *
Untitled Title
First Responder Name *
What line of duty was the person called to? *
Can you tell us about the tragic circumstance of the first responder or their family? (Deceased? Seriously injured? Long term or serious illness?) *
Does the first responder have children? *
Who are the immediate family members of the first responder in need? Specifically those who will be beneficiaries. (Name, Relationship to First Responder, Age) *
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