V.A.N. (Victims Assistance Network) Form
Please provide details regarding the V.A.N. request, and a CLIF representative will contact you within 48 hours.
Name of Recommender
Email of Recommender
Name of Recipient
Email of Recipient
Address (location for care package, if applicable)
Phone Number of Recipient
Medical Bill Assistance (Pending Committee Approval)
Grief Counseling Sessions
Please provide specific details regarding car crash (date of crash, location, individuals involved, cause of crash, injuries, media story links, etc) and the recipient.
Send me a copy of my responses.
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