Employee Restoration Fund

The purpose of the Restoration Fund is to provide short-term, emergency support to Jasper employees and dependents who are facing financial emergencies as a result of unforeseen and unpreventable circumstances. The restoration fund grants are not to exceed $2,500.

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Please read the following and verify that you qualify as an applicant and that your emergency qualifies. Examples of events which may lead to a Financial Emergency include, without limitation, the following: fire, natural disaster (flood, tornado, etc.), accidents, loss of property including theft, illness, disability, and death. Examples of health, safety, or basic welfare needs may include medical and dental expenses resulting from an accident or illness not covered by insurance, replacement of clothing and household items destroyed by fire, and utilities and other basic living expenses.

The recipient must be one of the following. Please check which applies to you

Current Jasper Ventures Employee who has been employed by Jasper Ventures, Inc., or its affiliated companies for a period of 6 months. Spouse or dependent family member of a current Jasper Ventures Employee.

For purposes of the Restoration Fund, a “Financial Emergency” shall be an event or combination of circumstances that... (check all that apply):

Was unforeseen and unpreventable. Adversely affects a Jasper Venture employee’s or dependent family member’s health, safety, or basic welfare.

First Name

Last Name

Phone

Street Address

Address Line 2

City

State

ZIP / Postal Code

Department & Supervisor Name

Describe fully your reason for applying for the Employee Restoration Fund.

Describe what steps you have taken to resolve your emergency.

Describe how the incident has caused your financial hardship.

Have you contacted 211 or looked at www.903help.org?

Yes No

Type your full name below for your signature

Date of submission

Restoration Fund Guidelines

Purpose

The Restoration Fund is a Jasper emergency assistance program funded by the Jasper Big Bass Tournament and employee donations. The purpose of the Restoration Fund is to provide short-term, emergency support to Jasper employees and dependents who are facing financial emergencies as a result of unforeseen and unpreventable circumstances.

Recipient eligibility requirements

The Recipient must be a (i) current Jasper Employee who has been employed by Jasper, or its affiliated companies for a period of 6 months or (ii) a spouse or dependent family member of a current Jasper Employee.

Financial emergency

For purposes of the Restoration Fund, a “Financial Emergency” shall be an event or combination of circumstances which both (i) was unforeseen and unpreventable and (ii) adversely affects a Jasper employee’s or dependent family member’s health, safety, or basic welfare. Examples of events that may lead to a Financial Emergency include, without limitation, the following: fire, natural disaster (flood, tornado, etc.), accidents, loss of property including theft, illness, disability, and death. Examples of health, safety, or basic welfare needs may include medical and dental expenses resulting from an accident or illness not covered by insurance, replacement of clothing and household items destroyed by fire, and utilities, and other basic living expenses.

Restrictions

Financial Assistance may be awarded in any amount up to a maximum of $2,500 per application.

A maximum of one grant will be allowed to any one person or family unit, during a two-year period (with a maximum of two grants per employee’s lifetime while working at Jasper).

There is no recourse of appeal to committee’s decisions and there is no guarantee of approval.