JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Assistance Application
Has your loved one been killed or injured in the line of duty? Team BlueLine was created to help you! Please fill out this form so we can learn more about you and how we can help.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
Your answer
Last Name
Your answer
Email Address for officer/family (if seeking assistance for someone else)
Your answer
Mailing Address
Your answer
I am applying for assistance for...
Myself
My Spouse
My Child
Other:
Clear selection
Team BlueLine was formed to provide assistance to persons who serve or have served in a sworn law enforcement role. Please confirm if you (or the person for whom you are submitting this request) are a current or former law enforcement officer:
*
Currently serving as a sworn law enforcement officer
Former sworn law enforcement officer
Applicant does not meet this requirement
Please tell us your situation and why you need assistance from Team BlueLine:
Your answer
How can TBL help?
Financial Needs
Service Dog
Barry Faust Scholarship Fund
Other:
Clear selection
Please explain further about what you need and how TBL can help (include financial burden if applicable).
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
