Apply for Help | Jack Vasel Memorial Fund

Full Name *

Email Address *

Street Address *

City, State/County, Postal Code *

Country *

How are you a member of the gaming community? *

Please tell us a bit about your hardship: *

Do you have a specific request from us?

What does support look like to you right now?

What are the immediate needs that are going unmet?

What are some of the practical items you've lost that would make your life easier right now?

Is there a nearby store that is a national chain where your immediate needs could be met?

Is there a specific dollar amount that you would like to ask for to help with immediate needs?

If that dollar amount is approved, what would the money or gift cards be used for?

Were you insured? Have you had any conversations with your insurance company regarding this incident?

Are you currently working? Have you been able to take time off work to handle this?

How have friends and family been able to help?

Anything else?

Supporting Documentation (THIS WILL VASTLY IMPROVE the speed in which we can help you!)

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Document 5

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