2024 Ridgeview Employee Crisis Fund Application

Qualification of Employee Applicants

All employees of Ridgeview are eligible to receive up to $500 awards, however they must be employed at Ridgeview for a minimum of six consecutive months.
All employees requesting funds must be able to demonstrate need consistent with the qualifying criteria.
Applicants may not have had more than two $500 grants from the emergency fund in the previous 12 months or three grants from the emergency fund in the previous three years.
If you’ve received a grant from the Employee Crisis Relief Fund in the last six months you are ineligible to apply for a grant from the Employee Crisis Fund. After six months have passed from receipt of your Fund grant you are welcome to apply.

Please be aware receipt of funds from the Fund may have tax implications to you. As a result, Ridgeview reserves the right to later adjust or amend withholding or other amounts from later wages or other amounts payable to you.

All applications and details are confidential.

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* 1. Have you received the Employee Crisis Relief Grant funds in the last six months?

Yes-If you’ve answered “yes” to this question, you must wait six months until you are eligible to apply for a Ridgeview Employee Crisis Grant.

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* 2. First name

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* 3. Last name

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* 4. What is your employee number?

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* 5. Ridgeview job title

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* 6. Department

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* 7. Preferred phone number

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* 8. Preferred email address

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* 9. How long have you been employed at Ridgeview Medical Center?

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* 10. Please describe your qualifying criteria leading to the current need:

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* 11. Gift cards for basic living expenses (gasoline, groceries, etc) are available. Please indicate if you would prefer to receive gift cards or reimbursement on your paycheck.

Gift Cards

Reimburse for basic living expenses

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* 12. Please upload documentation of basic living expenses such as mortgage, rent, car payments, household utilities, day care, groceries and medical bills to be reimbursed for.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 13. Is this the first time you have requested a grant Ridgeview Employee Crisis Funds?

Yes

No (Please indicate when you received them)

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* 14. I understand that by accepting these funds, I may impact my personal tax liabilities.

Yes

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* 15. I declare that the information on this application is true and correct.

Yes