Name: *
Your answer
Social Security Number *
Your answer
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Email Address: *
Your answer
Phone: *
Your answer
Name of Company/Institution
Your answer
Describe the Situation *
To assist the Trustees, please describe in detail the situation resulting in your request for assistance and indicate how the situation relates to the purposes of this Fund. In your narrative description, please include the names of individuals involved in your situation and their roles in the events you have documented. Also, please specify the times and places for the events you have described, and include as attachments any supporting documentation(press reports, memos, etc.). Your narrative also should contain an explanation of the financial ramifications of your situation and explain why you are asking for the amount of aid you are requesting in this application.
Your answer
Legal Counsel *
If you are presently represented by legal counsel, please provide counsel’s name and contact information. In addition, please ask your counsel to provide the Trustees with a brief overview of the legal issues in the case and the status of the case to date.
Your answer
References *
Please include the names, relationship and contact information of three people from your local community who are familiar with your current situation. We recommend that these people not be members of your immediate family
Your answer
Additional Information
Your answer
If you would like to email additional supporting documentation as an attachment, please send to ybrown@ala.org.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms