Hormel Foods Corporation Crisis Assistance Relief Effort (CARE) Fund Application

The Crisis Assistance Relief Effort (CARE) Program is designed to help team members of Hormel Foods and its subsidiaries who find themselves in a financial hardship situation caused by a qualifying crisis event or emergency situation.

To be eligible, the hardship must result from a crisis event or emergency situation affecting an active United States resident team member and/or a member of their immediate family*

A maximum grant of up to $2,000 may be given to eligible applicants (maximum of two grants for separate crises; totaling no more than $4,000 in a 12-month period).

Team Member Information

Team Member First Name

Team Member Last Name

Work Location

Work Location Address - If you selected Jennie-O Corporate Departments, Jennie-O Live Production, Sales Office, or Other (the work location was not listed) please provide the address:

Mailing Address: Street and/or PO Box, City, State and Zip Code

Team Member ID

If this grant application is approved by Southwest Initiative Foundation, are you the individual seeking funds or are you filling this application out on behalf of someone (choose an option below):

Please provide your contact information: (Oppty detail - grant app)

First Name

Last Name

Email Address

Email Type

Phone

Phone Type

Please identify who you are filling this form out on behalf of:

*Immediate family member definition: lawful spouse/domestic partner**, unmarried dependent children, unmarried dependent step-children**, or children for whom the team member is deemed to be the legal guardian. In cases of death, this definition also includes the team member’s birth or step-parents. **"The definition of domestic partner and/or dependents, as found in the Hormel Foods Health Care Plan Summary Plan Description, will be used to determine or clarify dependent status, if necessary. Verification of relationship may be required, such as marriage license, birth certificate, tax return, etc."

I am:

Please describe your relationship to the Team Member:

Beneficiary Contact Information:

Other Relationship to the Team Member:

Lawful Spouse or Domestic Partner Contact Information:

Active Team Member Contact Information:

First Name

Last Name

Email Address

Email Type

Phone

Phone Type

Mailing Address

City

State

Zip Code

Crisis Event: provide as much detail as possible

Crisis Type

NOTE: Examples of ineligible events include, but are not limited to: medical bills, travel to funerals or to visit sick relatives, travel to any foreign country, events that occurred more than 60 days before the date the application was received, and any expenses that are not directly related to an identified crisis or emergency.

Date of Onset

Days Missed

Requested Amount $

Minimum is $500; Maximum Award is $2,000

Provide a detailed description of crisis event that caused the financial hardship and intended use of grant dollars.

Attach a file of valid supporting documents, such as bills or invoices (non-medical). This is required. Click add another response if you have more than one document to upload.

If this application is approved by the Southwest Initiative Foundation, how should this payment be sent?

Address where check should be mailed:

Street Address

City

State

Abbreviation

Zip Code

After clicking submit, read the signature agreement, complete the signature page and then confirm the signature using the link in the email you will receive after signing. The grant application is not signed until you confirm the signature from your email.

Contact Information