Welcome to the application for the Sport Clips Eric Gozur - Wayne McGlone Memorial Relief Fund.
All required fields must be filled out and required documentation uploaded in order to submit an application.
You may "save and resume" your application, but you will have to re-upload all documentation when you resume.
- Employees who have worked for Sport Clips, Inc. or a Franchisee of Sport Clips, Inc. for three or more consecutive months; an exception to the three month minimum rule may be made by a unanimous vote of the Independent Review Committee. - Full-time or part-time employees are eligible regardless of whether hourly or salaried or position held. - Surviving dependents or family members of a deceased, eligible employee who was employed by Sport Clips at the time of death.
Independent Review Committee members have the discretion to award relief payments up to the maximums listed below. Relief payments are primarily based on out-of-pocket, documented (by an outside party - such as a receipt) expenses, and depending on the circumstances, a relief payment may be less than the requested amount. The amount of each relief payment will be evaluated based on individual need, financial ability to cope with the event (which would take into consideration insurance coverage for the event), and the Fund balance.
- Death of an employee or immediate family member: $15,000 ($5,000 limit for the death of a parent) - Serious injury or illness of any employee or family member within the same household: $10,000 - Loss of or severe damage to housing resulting in financial hardship: $10,000 - Loss of or severe damage to automobile resulting in financial hardship: $ 5,000 - Other unexpected catastrophic events: $10,000
Total relief payments to any one employee and/or their family within the same household may not exceed $25,000 in any twelve month period.
Please note that lost wages incurred from a company other than Sport Clips, Inc. for a spouse or family member living in the same household are not eligible for a relief payment.
Please note that the following are not eligible for a relief payment: - General maintenance and/or repairs for a vehicle. - Auto accidents involved in a lawsuit or legal action of any kind.
INSTRUCTIONS FOR THE "STATUS" BELOW:
HOLD - If there is not consensus, CTXCF Staff must email (from firstname.lastname@example.org) the members of the appropriate committee (all of them or only the one that doesn't seem to reflect the submitted documentation) with a brief explanation of the discrepancy. Copy and paste the data or get a copy of the application form as a PDF from Formstack that will have ALL the data for a particular application. DO NOT ENTER ANYTHING INTO "STATUS" BELOW UNTIL A MAJORITY VOTE IS ACHIEVED, THE APPLICATION WILL BE ON HOLD UNTIL "STATUS" HAS A SELECTION AND THE SUBMIT BUTTON HAS BEEN CLICKED.
APPROVED - If there is consensus for the vote among all committee members AND there is consensus about an amount to be awarded, complete this section of the Form and click "Submit".
DENIED - If there is consensus to deny a relief payment to an applicant OR CTXCF Staff has determined the application is ineligible, continue to the next step in the process by completing this section of the Form.