Forms → Staff → Union → SEIU/MCPS Emergency Assistance Program
Form number: 430-25
Audience: MCPS Staff, SEIU Members
Last revised: January 2023
Staff should complete this completed form to email@example.com along with required documentation.
To apply for assistance, the bill or notice must be in the employee's name and must be submitted to the fund within 30 days of the notice or bill. A copy of the bill or payment receipt must be attached with the submission. Employees must either be actively working, on paid leave, been covered by a sick leave grant within six months, even if on unpaid leave, and cannot be on administrative leave or unusual or imperative leave without pay.
For questions about this benefit, including your eligibility, you can contact firstname.lastname@example.org or call 301-740-7100. If you get an answering service, please leave a message with a good contact number.
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