SYD TLC Fund Request Form

The SYD TLC Fund was established to provide financial assistance to team members and/or legal dependents who encounter significant financial hardships resulting from a qualifying incident. This initiative is designed to help alleviate the financial burden that can arise from unexpected situations such as medical emergencies, natural disasters, or other unforeseen circumstances.

When an application for assistance is submitted, it will undergo a thorough review process conducted by the SYD Employee Assistance Grant Advisory Committee. This committee is responsible for evaluating each application to assess the validity of the assistance claim and determine the appropriate level of support. Importantly, all applications and any related information will be handled with the utmost confidentiality to protect the privacy of those involved.

The grant limit is $2,000 for full-time employees, with a cumulative amount of $2,000 in a 365-day period. The grant limit is $1000 for part-time employees, with a cumulative amount of $1,000 in a 365-day period. The minimum grant amount is $250.

If an application is approved, SYD Employee Assistance will distribute funds in the most appropriate way for the situation. Payments will be made directly to the vendor or service provider to whom the associate owes money, ensuring that the funds are applied where they are most needed. Alternatively, if the associate has already settled the payment and has a paid receipt as proof, they may receive reimbursement directly from the fund. This process aims to ensure swift and effective assistance to those in need during their challenging times.

Applications will not be considered until they are complete. Applications must be submitted within 90 days of the qualifying incident.

APPLICANT ELIGIBILITY
Please check all that applies*
- Is a full or regular part-time (0.5 FTE) active employee of SYD
- Has completed a year or more of continuous service
- Has had no disciplinary or performance warnings for the 12 months before the application date
- Has experienced a qualifying incident in the past 90 days
EMPLOYEE INFORMATION
Name*
First Last
Preferred email address*
Preferred daytime phone number*
Title*
Tenure with SYD*
Note: must be at least one year (indicate years)
The situation being experienced is an unexpected, unusual and/or extraordianary event*
- Yes
- No
Please describe the incident that has caused hardship.*
The hardship involves and affects me and/or my immediate family (spouse, children, step-children, siblings, parents, and/or grandchildren who depend financially on me)*
- Yes
- No
If yes, please describe*
Please describe how the incident prevents you from meeting your financial obligations.*
Please list all the efforts you have taken to alleviate this hardship including other sources of financial aid or social aid:*
Name of Immediate Supervisor*
First Last
REQUIRED DOCUMENTS
LIST OF BILLS / UTILITIES NEEDING ASSISTANCE*
Company owed Address of company Essential need provided Amount Owed Date Due
UPLOAD COPIES OF CURRENT BILLS/INVOICES FOR WHICH GRANT IS REQUESTED
Upload current bills/invoices (PDF FILE FORMAT PREFERRED)*

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 300 MB.
Upload current bills/invoices (PDF FILE FORMAT PREFERRED)

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 300 MB.
Upload current bills/invoices (PDF FILE FORMAT PREFERRED)

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 300 MB.
EMPLOYEE CERTIFICATION STATEMENT AND SIGNATURE
Because of an incident beyond my control, I am in need of financial support to meet my immediate obligations. By signing this application, I certify that all of the information contained in this application is true and correct. I authorize the SYD TLC Fund Grant Advisory Committee to obtain and/or verify all information necessary to process this application. Additionally, I understand that no employee is automatically entitled to receive a grant, either by their employment or because of any precedent inferred from a previously-approved grant. I understand grants will not be made before an associate has demonstrated an immediate need.

I also understand that, although the grants are made from the SYD TLC Fund, it is possible that a grant might result in taxable compensation to the employee.
Employee Signature*
I understand that by typing in my name constitutes a legal signature confirming that I acknowledge and agree to the above terms.
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Company owed	Address of company	Essential need provided	Amount Owed	Date Due

SYD TLC Fund Request Form

APPLICANT ELIGIBILITY

EMPLOYEE INFORMATION

REQUIRED DOCUMENTS

UPLOAD COPIES OF CURRENT BILLS/INVOICES FOR WHICH GRANT IS REQUESTED

EMPLOYEE CERTIFICATION STATEMENT AND SIGNATURE