Request Assistance
Austin Firefighters Outreach Fund provides
immediate financial assistance to firefighters
and their families impacted by an unexpected
injury, illness, or death. Additionally the “Fund”
provides assistance to citizens of Travis and
surrounding counties who experience a major
catastrophe involving fire, flood, tornado and
other natural disasters.
immediate financial assistance to firefighters
and their families impacted by an unexpected
injury, illness, or death. Additionally the “Fund”
provides assistance to citizens of Travis and
surrounding counties who experience a major
catastrophe involving fire, flood, tornado and
other natural disasters.
To apply please fill out the attached
(click here) FORM and mail, email or fax it to;
Austin Firefighters Outreach Fund
7537 Cameron Rd.
Austin TX 78752
austinfirefightersfund@yahoo.com
512-380-0803
(click here) FORM and mail, email or fax it to;
Austin Firefighters Outreach Fund
7537 Cameron Rd.
Austin TX 78752
austinfirefightersfund@yahoo.com
512-380-0803
Our Services
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| Austin Firefighters Outreach Fund |
Check # ___________________
Austin Firefighters Relief and Outreach Fund
(512) 441-7572 ٠ Fax (512) 494-9080
7537 Cameron Rd ٠ Austin, TX 78752
The Austin Firefighters Relief and Outreach Fund provides immediate financial assistance to firefighters and their families impacted by an
unexpected injury, illness, or death. Additionally, the “Fund” provides assistance to citizens of Travis and surrounding counties who experience a
major catastrophe involving fire, flood, tornado and other natural disasters.
Approved by ________________________
________________________
Disaster Relief Request (Please print all information)
________________________________________________________________________
Name(s) (circle one) civilian / police / firefighter
___________________________________________________________________________________________________________
Pre-disaster Address
________________________________________________________________________
Current Address Temporary or Permanent (circle one)
_____________________________ __________________________________
Telephone Number(s) Email Address
________________________________________________________________________
Name of Disaster
Type of assistance needed?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
1.) Do you have home owners or renters insurance? Yes / No
2.) Are you temporarily displaced from your residence? Yes / No
If yes, until what date (approx.)? ___________________
3.) Do you have dependent children or adults in your care?
Age Relationship Age_ Relationship
Example: 5 Grandson 3) _____ __________
1) ____ _____________ 4) _____ __________
2) ____ _____________ 5) _____ __________
4.) Have you received assistance from any other organizations? Yes / No
If yes, please list organizations ________________________________________
_________________________________________________________________________________________________
5.) How did you hear about our organization? __________________________________
_________________________________ _______________________
Signature Date
Check # _________________
Austin Firefighters Relief and Outreach Fund
(512) 441-7572 ٠ Fax (512) 494-9080
7537 Cameron Rd ٠ Austin, TX 78752
El “ Austin Firefighters Relief and Outreach Fund” proveé ayuda financiera inmediata para los bomberos y sus familias efectados de un daño
inesperado, enfermedad, o muerte. También el “Fund” proveé ayuda a la gente de Travis y los distritos cercos que fueron a tener una experiencia
de un catástrofe grave, como fuego, torrente, tornado, o otro desastre natural.
Approved by ________________________
__________________
Solicitud para Alivio de Desastre (Favor de escribir con letras de imprenta)
Fecha del desastre _____________________________________________
____________________________________________________ civil / bombero / policia
Nombre(s) (círculo uno)
____________________________________________________________________________________________________________
Dirección antes del desastre.
________________________________________________________________________
Dirección ahora Temporal o Permanente (círculo uno)
__________________________________ ____________________________________
Número(s) de teléfono Dirección de Email
________________________________________________________________________
¿Cuál desastre? (y grado de perdido)
Tipo de ayuda que necesita:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
1. ¿Tiene seguro para la casa o para rentar? Sí / No
2. ¿Está desplazada temporalmente de su casa? Sí / No
Si sí, hasta que fecha (approx.)? ________________________________________
3. ¿Tiene niños dependientes o adultos en su cuidado? Sí / No
Edad Relación Edad Relación
Por ejemplo: 5 Nieto 3) _____ __________
1) ____ _____________ 4) _____ __________
2) ____ _____________ 5) _____ __________
4. ¿Ha recibido ayuda de otras organizaciónes? Sí / No
Si sí, favor de hacer una lista de las organizaciones. ______________________________________
___________________________________________________________________________________________________
5. ¿Cómo oyó usted de estos fondos y cómo alistarse para ellos? ________________
_________________________________ ________________________
Signatura Fecha
Austin Firefighters Relief and Outreach Fund
(512) 441-7572 ٠ Fax (512) 494-9080
7537 Cameron Rd ٠ Austin, TX 78752
The Austin Firefighters Relief and Outreach Fund provides immediate financial assistance to firefighters and their families impacted by an
unexpected injury, illness, or death. Additionally, the “Fund” provides assistance to citizens of Travis and surrounding counties who experience a
major catastrophe involving fire, flood, tornado and other natural disasters.
Approved by ________________________
________________________
Disaster Relief Request (Please print all information)
________________________________________________________________________
Name(s) (circle one) civilian / police / firefighter
___________________________________________________________________________________________________________
Pre-disaster Address
________________________________________________________________________
Current Address Temporary or Permanent (circle one)
_____________________________ __________________________________
Telephone Number(s) Email Address
________________________________________________________________________
Name of Disaster
Type of assistance needed?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
1.) Do you have home owners or renters insurance? Yes / No
2.) Are you temporarily displaced from your residence? Yes / No
If yes, until what date (approx.)? ___________________
3.) Do you have dependent children or adults in your care?
Age Relationship Age_ Relationship
Example: 5 Grandson 3) _____ __________
1) ____ _____________ 4) _____ __________
2) ____ _____________ 5) _____ __________
4.) Have you received assistance from any other organizations? Yes / No
If yes, please list organizations ________________________________________
_________________________________________________________________________________________________
5.) How did you hear about our organization? __________________________________
_________________________________ _______________________
Signature Date
Check # _________________
Austin Firefighters Relief and Outreach Fund
(512) 441-7572 ٠ Fax (512) 494-9080
7537 Cameron Rd ٠ Austin, TX 78752
El “ Austin Firefighters Relief and Outreach Fund” proveé ayuda financiera inmediata para los bomberos y sus familias efectados de un daño
inesperado, enfermedad, o muerte. También el “Fund” proveé ayuda a la gente de Travis y los distritos cercos que fueron a tener una experiencia
de un catástrofe grave, como fuego, torrente, tornado, o otro desastre natural.
Approved by ________________________
__________________
Solicitud para Alivio de Desastre (Favor de escribir con letras de imprenta)
Fecha del desastre _____________________________________________
____________________________________________________ civil / bombero / policia
Nombre(s) (círculo uno)
____________________________________________________________________________________________________________
Dirección antes del desastre.
________________________________________________________________________
Dirección ahora Temporal o Permanente (círculo uno)
__________________________________ ____________________________________
Número(s) de teléfono Dirección de Email
________________________________________________________________________
¿Cuál desastre? (y grado de perdido)
Tipo de ayuda que necesita:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
1. ¿Tiene seguro para la casa o para rentar? Sí / No
2. ¿Está desplazada temporalmente de su casa? Sí / No
Si sí, hasta que fecha (approx.)? ________________________________________
3. ¿Tiene niños dependientes o adultos en su cuidado? Sí / No
Edad Relación Edad Relación
Por ejemplo: 5 Nieto 3) _____ __________
1) ____ _____________ 4) _____ __________
2) ____ _____________ 5) _____ __________
4. ¿Ha recibido ayuda de otras organizaciónes? Sí / No
Si sí, favor de hacer una lista de las organizaciones. ______________________________________
___________________________________________________________________________________________________
5. ¿Cómo oyó usted de estos fondos y cómo alistarse para ellos? ________________
_________________________________ ________________________
Signatura Fecha