This form should only be completed by an employee of a union for the purposes of referring their union's members for emergency assistance. Submission of this form verifies that the individual referred is a current member, in good standing.

Please note - Two additional request types have been added to the form:
- Financial literacy training - Labor Community Services (LCS) will determine whether the member qualifies for a one-on-one session with SOFA (Society for Financial Awareness)
- Referral to St. John's Well Child & Family Center - LCS will determine whether the member and/or their family should be referred to St. John's for a free doctor's visit, and appointment with a Benefits Counselor

Name of the person completing the referral form.

Position within the union of the individual completing the form.

How can we contact you?

This form is only for union staff referring members of their union.

Emergency, financial assistance is ONLY available to union members in good standing.

How many people live in the union member's home?

What does the union member need assistance with?

Union members are eligible for assistance one time per calendar year.

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