Aid To Family/Assistance Request Form

Preliminary Request for Assistance Form Important Note: This preliminary request for assistance form(s) must be received within (6) weeks of a qualifying event to receive consideration. Additional information will be required for your consideration of and receipt of financial benefits. ▸ 1. Victim’s Human Resource Department needs to complete the Assistance Request Form Below for the employee’s spouse and beneficiary. ▸ 2. HR can submit a Memorial Statement to ▸ 3. Questions? Contact Jennifer McCloskey. or 954-817-9590.