Employee Name *

First Name

Last Name

Past Requests Information

If this is your 3rd request for assistance since the beginning of this program in 2006 – Do you give your permission to have this request go out to the giving committee along with your name and the amounts you have received in the past? (We will be unable to submit your request without your approval)

Yes, I give permission to have this request go out to the giving committee along with my name and the amounts I have received in the past.

Existing Company Loan

If you are requesting a company loan, or the committee recommends you for a company loan, do you give your permission for the company administrative assistants to discuss your request with your supervisor & HR to confirm you are in good standing as an employee? (We will be unable to process a company loan without your approval)

Yes, I give my permission for the company administrative assistants to discuss my request with my supervisor & HR to confirm I am in good standing as an employee.

Request Type

I am Requesting Assistance from Helping Hands

I am Requesting a Loan (Payroll Advance) that I will pay back