In order to qualify for financial assistance through the GCSASC Benevolence Fund:
Person/Family in Need First Name: ________________________________________________________ Last Name: ________________________________________________________ Mailing address: ______________________________________________________________________________ Relationship to the Golf Industry: _______________________________________________________________________ Employment Status (circle): Full, Part, Self, Retired, Unemployed, Collecting Social Security, Disabled, other: Current or Last Place of Employment: _______________________________________________________________________ Current or Last Employment Title: _______________________________________________________________________ Other employment history (brief): _______________________________________________________________________ Does the individual have medical insurance? Y/N If yes, out of pocket max: ___________________ Is there a GoFundMe/Caring Bridge account set up in their name? ______________________________________ Is there a fundraiser planned for the family? _____________________________________________________________ How much money is needed? _______________ Please describe the situation of need: ______________________________________________________________________________ Application Submitted by: First Name: _________________________________________________ Last Name: _________________________________________________ Email Address: ______________________________________________ Phone: ____________________________________________________ Please submit request via email to molly@duvallmanagement.com, it will be sent to the Benevolence Committee. They will use the information provided to deem the extent of the need and funding source. All information will be kept confidential. If you have any questions, please feel free to contact the GCSASC at the above email address or phone 760-397-7944. |