So that we may better evaluate your needs, please share your reasons for requesting assistance and how you feel you and your family would most benefit from our assistance. Please also describe the circumstances that have created the need for this relief.
1. I certify the above information to be true. I understand that if any information is found to be false, my assistance may be subject to termination.
2. If my financial circumstances improve or reach a level where I no longer require assistance, I agree to notify the Florida Restaurant Employees Red Tide Relief Fund, Inc. so that others in need may avail themselves of assistance.