Aid To Family/Assistance Request Form

Preliminary Request for Assistance Form Important Note:

This preliminary request for assistance form must be received within (6) months of a fatal work-related construction accident for consideration. Additional information may be required for receipt of financial benefits.

▸ 1. Please complete the information Below for the employee’s spouse and beneficiary. Construction Angels will verify employment after form is completed

▸ 2. For questions, please contact Kristi Ronyak at Kristi@ConstructionAngels.us or 954-274-6633.