Individual Grant Application PLEASE NOTE: You are required to submit an address. Only one award per household. Awards will cover only the following requests: Funerals What kind of first responder are / were you?First responders are medical personnel treating COVID-19 patients, paramedics, emergency medical technicians, police officers, firefighters, and employees directly supporting police and fire departments such as 911 dispatchers. All others will be declined from the grant award.Emergency medical technician (EMT)FirefighterMedical personnelParamedicPolice officerOther position supporting first responders such as 911 dispatcherWhat is your job description?*What is your work status?Full TimePart TimeVolunteerRetiredDeceased (Please select if you are applying on behalf of a first responder family member who passed due to COVID complications)Has anyone in your family applied and/or received a grant from the Foundation?*(Family unit is Father, Mother, Sibling, Partners, Spouse, Grandparents, Children, Roommate)YesNoHave you previously submitted an application for the Individual Grant?*YesNoDemographic InfoGender*MaleFemaleOtherNumber of people in your Household*Please enter a number greater than or equal to 0.Number of Children (18 or younger) you support*Please enter a number greater than or equal to 0.Verification - Please submitMaximum allowed 128MB per file upload. Formats allowed (jpg, gif, png, jpeg, pdf, doc)* Having problem uploading files? Visit Guide & TroubleshootingProof of first responder status* (Copy of ID or credentials, letter from agency, etc) Drop files here or Proof of financial distress*(Funeral bill or death certificate / childcare expenses / loss of housing documentation) Drop files here or Impact Statement*(Describe child or elder-care related expenses, funeral bills, hospital bills, and loss of home.) First and Last Name* First Badge / ID Number*Proof of First Responder Status (Department ID, EMT ID, Hospital ID, State ID, any valid ID that states your name, may have a photo and shows your a first responder/ Certificate of Training is not a valid ID) Agency / Affiliation*Home Address of Applicant* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant Phone Number*Email* I have been honest of my need and statements in this application*YesNoSupervisorPlease provide a direct line to your Supervisor at your Agency/Place of employment - cell phone numbers not applicable.Name* First Email* Phone*I certify the accuracy of the information provided in this application and in any supporting documentation that I may submit to First Responders Children’s Foundation. My family and I have been financially impacted by the COVID-19 pandemic which has resulted in financial hardship. I hereby authorize the release of information to First Responders Children’s Foundation for the purpose of verifying any information in my application. I understand that falsified statements on this application in any detail shall be considered sufficient cause for disqualification from further consideration. As we are experiencing a high volume of applications, a post review of your application will be done. Should information be found to be untruthful, we will report the issue to your employer and supervisor.