Arpan Employee Relief Fund
First Name
Last Name
Employee Joining Date
Employee ID
Gender
Male
Female
Email
Phone Number
Alternate Phone Number
Address
Department
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Designing
Development
Testing
1. Describe the circumstances surrounding the need for assistance. Please include with this application documents substantiating or supporting your need for assistance.
Any Other Comment:
I certify that the information provided is true and correct to the best of my knowledge, and that any money received will be used to relieve the stated financial hardship. I agree to provide the Committee administering this program with documentation regarding my hardship upon request. I also understand that money receive from this fund will be treated as taxable income and is a one-time award. Any intentional misrepresentation of information contained in this application or shared during its review will result in forfeiting this and any future application for assistance, possible disciplinary action and a potential demand for repayment of funds issued. Furthermore, I understand that the completion of this application does not guarantee funding, and that if needed I will address any concerns or questions related to my application.
Terms of service
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