Employee Financial Assistance Application Employees > Emergency Financial Assistance First Name * Last Name * Which company do you work for? * Senior Living Communities Wellmore Live Long Well Care Home Office Location Please Choose (SLC)BrightwaterCascades VerdaeEvergreen WoodsHomestead HillsLakes LitchfieldMarsh's EdgeOsprey VillageRidgeCrestSummit HillsThe CharlotteThe GablesThe StratfordWildewood Downs Location Please Choose (WM)Daniel IslandLexingtonTega Cay Location Please Choose (LLWC)BrightwaterCascades VerdaeHomestead HillsLakes LitchfieldMarsh's EdgeOsprey VillageRidgeCrestSummit HillsThe StratfordWildewood DownsWellmore of Daniel IslandWellmore of LexingtonWellmore of Tega Cay Employee ID # * Date of Employment * Position * Employment Status * Full-TimePart-Time Email * Phone * Total Household income as reported on 2024 IRS Tax Return. (To be verified by HRD) * How many dependent children live in the house? * Please Choose012345678910 What is your marital status? * Please ChooseMarriedWidowedSeparatedDivorcedSingle Amount Requested (up to $1,000) * Reason for Assistance * Please ChooseCar repair/paymentFood assistanceUtilities shut off/paymentHouse evictionDomestic violenceHouse repairs when not created through natural disaster (air-conditioner replacement, plumbing, etc.)Non-life threatening medical emergency for primary family memberLife threatening medical emergency for primary family member (cancer, heart attack, etc.)Death of a primary family memberDomestic violenceCatastrophic loss of property due to a natural disaster (fire, flood, tornado, earthquake, hurricane, etc)Other Explain in detail the reason and urgency for needing assistance.Provide supporting documentation to your HR Director (Ex. Car repair estimate, Repossession notice, Home eviction notice, Past due bill, Accident report, Insurance claim form)Until household income and supporting documentation are provided to the HRD, applications will not be reviewed. * Date Assistance is needed by (Once you provide the required documentation to your HRD, the minimum time for you to receive a response is seven business days.) * By submitting this application, the applicant agrees to the following: In order to confirm the Applicant meets the financial needs requirements of the program, the Applicant will provide the Foundation with Applicant’s most recently filed Federal income tax return or Forms W-2 and 1099 for Applicant and Applicant’s spouse. Failure to provide substantiating information shall disqualify the Applicant from receiving an award under the program. The Foundation may request employment records from Maxwell Group to confirm satisfaction of the requirements for receipt of an award under this program. The Foundation may utilize Applicant’s banking records on file with Maxwell Group for the sole purpose of making ACH transfers of any amounts awarded under the program. If Applicant prefers to utilize different banking information, Applicant must submit preferred ACH information to the Foundation along with this application. All records provided to the Foundation in connection with this application will be held confidentially and will not be disclosed to third parties by the Foundation except as provided by law. Captcha Submit If you are human, leave this field blank.