GET STARTED

I hereby acknowledge that I have read the Assistance Guidelines and to the best of my knowledge, believe that I may qualify for a grant or, that the individual I am submitting on behalf of is eligible.

During the full application process, documentation such as bill statements, bank statements, and pay stubs will be required.

We will confirm your employment status with two levels of management to ensure good standing (satisfactory performance or better, no current or pending disciplinary actions, and no customer complaints.)

All requirements must be acknowledged before the form can be filled out.

Employee Complete First & Last Name
*

Employee Number
*

Employee Phone
*

Employee Email
*

Employee Full Home Address, City, State, Zip
*

Employee Full Work Location Address, City, State, Zip & Brand Name
*

Recipient Name (if different than employee)

Recipient Relationship to Employee

Recipient Home/Personal/Alternate Phone
*

Recipient Home/Personal/Alternate Email
*

Describe the recent natural disaster, catastrophic event or serious
illness that caused the personal financial hardship
*

To help us better understand your situation and determine how Rollins Employee Relief Fund may be able to assist, please describe the specific support you are seeking. For example, you may be requesting assistance with rent or mortgage payments, utility bills, food expenses, or other essential financial needs.
*