Wildfire Fire Member Assistance Application

In light of wildfire's impact throughout Oregon, SEIU 503 is offering one-time financial assistance of up to $250.00 to help members and their families impacted by fire and evacuations. Please fill out the form below to apply.

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* 1. Financial assistance will only be made available to SEIU 503 members in good standing.

I am a SEIU 503 member

I am filling this out on behalf of an SEIU member

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* 2. Name

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* 3. Email

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* 4. Best Phone

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* 5. Mailing Address

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* 6. Please tell us how you would like to receive payment

Paypal - FASTEST OPTION

Paper check via mail - Checks will be sent to mailing address above

Other (we will try to accommodate other payment arrangements)

Wildfire Fire Member Assistance Application

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* 1. Financial assistance will only be made available to SEIU 503 members in good standing.

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* 2. Name

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* 3. Email

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* 4. Best Phone

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* 5. Mailing Address

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* 6. Please tell us how you would like to receive payment

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* 7. If you select to receive payment via Paypal, please confirm the email address associated with your Paypal account.

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* 8. Please briefly describe how you have been affected by wildfire this year.