• Employee Assistance Fund (EAF)

    Employee Assistance Fund (EAF)

  • APPLICATION FOR ASSISTANCE

  • THE PROGRAM: This Fund helps employees who are experiencing economic hardship and are unable to afford housing, utilities, and other basic living needs because of a natural disaster; life-threatening illness or injury; death or other catastrophic or extreme circumstances beyond the employee’s control.

    ELIGIBILITY: All Permobil employees who are 1) currently employed by Permobil; 2) in good standing with Permobil; and 3) past the 90-day introductory probationary period are eligible to apply for The Permobil EAF. Temporary employees are not eligible to apply. An employee can only be approved for assistance once within a 12-month period.

    GRANTS: The maximum grant amount available for assistance is $1000.00. 
    The maximum award is not guaranteed
    . Payments are typically made directly to vendors as bill payments and applicants will not be reimbursed if they pay the vendor directly.

    Permobil Foundation staff is available to assist all applicants with this process.
    Email
    EAF@PermobilFoundation.org to schedule a time.

  • SECTION A: WILL YOU QUALIFY?

  • SECTION B: YOUR GENERAL INFORMATION

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  • SECTION C: DESCRIBE YOUR SITUATION

    Which qualifying situation caused the financial hardship? Read the descriptions above on page 1 in Section A then select the category below that best fits your situation. (Email EAF@PermobilFoundation.org with questions)
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  • SECTION D: ASSISTANCE GRANTS

  • Grants are only to help pay for limited types of essential living expenses, which are:

    • Rent, mortgage or other housing payments
    • Temporary housing and security deposits for new/temporary housing incurred during incident
    • Essential utility bills (electricity, heat, water)
    • Medical expenses incurred within past 60 days related to the incident and not covered by insurance
    • Minor home repairs needed to maintain home safety and livability

    Grants cannot be made to pay for other, non-essential expenses such as:

    • Insurance premiums or deductibles
    • Cable, phone or internet service
    • Car payments, repairs or car insurance
    • Furniture, appliances, electronics
    • Funeral expenses or grave markers
    • Accumulated financial issues or credit card debt
    • Accidental damages due to negligence
    • Legal fees, legal fines or court costs
  • If the application is approved, payments will typically be made on your behalf to the vendor(s) you list. Grants are paid directly to vendors as bill payments and you will not be reimbursed if you pay the vendor directly. A letter will be emailed to you listing all payments made on your behalf including the amount and date sent.

    Provide the name of the vendor to be paid, the complete address, the account number or identifying information, amount due, and due date. The maximum grant amount is $1000.00, so list the vendors in order of priority. For each vendor, attach appropriate documentation (bills, lease, mortgage coupon, statement, etc

    NOTE : We cannot make payments without clear, complete information including full account numbers or other payment information, addresses and documentation. Omitting this information or copies of your bills will delay your application.

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  • SECTION E: DECLARATIONS AND AGREEMENT

  • No employee is entitled to receive a grant based on their employment. Grants will not be made before an employee has demonstrated an immediate financial need and provided all required documentation.

    This application will be treated in a confidential manner by the Permobil Foundation Board of Directors and one member of the Permobil Human Resource Department (based on your location); however non-identifying statistical information will be reported to Permobil on a periodic basis.

    Employees are expected to provide truthful and accurate information. In its due diligence, if the Permobil Foundation discovers any information to be untrue, it shall have the right to unilaterally waive its confidentiality and report its findings to Permobil. The fiduciary expectations of the Permobil employees are paramount and a breach of these standards will be reported to Permobil.

    Your signature below certifies that the information provided is true and complete, authorizes The Permobil Foundation to obtain and/or verify all information necessary to process this application, and releases Permobil and the Permobil Foundation from any liability associated with the rejection of or funding of this application. Submission of this application does not defer your responsibility to make payments and it is recommended that you communicate with your vendor. Remember that the maximum amount any employee or family member can receive in a 12-month period is $1,000. It is likely that, from time to time, lesser amounts will be awarded. In addition, you agree to provide the requested documentation supporting the information provided.

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  • Upload Required Documents

    If you have have more documents to upload than space allows, please contact us: EAF@PermobilFoundation.org for further instruction
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  • Application Checklist:

  • Please click the submit button below and the Permobil Foundation will alerted. We will contact you very soon.

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