Emergency Assistance

Download an Emergency Assistance Application below, or apply online (also below.)  Please be sure to review our policies, also available to download below.  There is also an Assistance Resource Brochure for California and Nevada that may direct you to other assistance programs you may qualify for.

SMEA Emergency Assistance:  Upon review and recommendation by the Financial Assistance Committee (FAC), SMEA may provide emergency assistance funds to eligible members in need due to a catastrophic event as defined in our policies.  All SMEA members are eligible to apply for assistance following 90 days of dues paying membership.  If you are mailing an application to us, please send to:

SMEA
2937 Veneman Ave # A115
Modesto, CA 95356
or FAX to:  888-620-8909

Examples of qualifying requests for assistance include, but are not limited to:

- Current medical expenses related to catastrophic injury/illness/disease (Ambulance, ER, Surgery)

- Loss of dependent household family (expenses when insurance coverage is inadequate)

- Fires/Floods where significant loss is incurred and insurance coverage is inadequate

Download Files Below

Emergency Assistance Application
Assistance Policies
California Resource Brochure
Nevada Resource Brochure

*First Name:

*Last Name:

Middle Initial:

*Address:

*City:

*State:

*Zip:

Hire Date:

*Telephone:

*Alt. Telephone:

*Employee ID#:

*Employee SSN:

Employee Status: Select One... Part Time Full Time

Store #, Division or Dept:

Reference:

Other Insurance:

Is your situation covered
by any insurance?:

Other Income:

Please list relationship and ages of all dependents:
(define as any person relying on your income)

Spouse Name:

Spouse Employer:

Years Employed:

Please list any additional information that supports your request for assistance:
(i.e. receipts, invoices, death certificate, any other documents showing proof of payment)

Please explain the reason (illness, hardship or catasrophic loss) you have made this request in as much detail as possible:

List specific financial needs:

I represent and warrant that the statements contained herein are true, accurate and complete to the best of my knowlege. I further represent and warrant that I have not omitted any information known to me that would materially affect the information I have disclosed or, if known by SMEA, might affect the outcome of its decision. I understand that these statements will be presented to the Administrator of the Employee Assistance Fund and used in support of the above named Emergency Assistance Application. I also understand the Adminstrator may take such action as prescribed by law if any false or fraudulent statements have been used in this application process.

Sign Full Name:

Today's Date:

 

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