Caregiver Emergency Fund: Los Angeles County Fires

During this challenging time, Keck Medicine and the Care for the Caregiver team can provide financial assistance to our Keck Medicine and Keck School of Medicine employees who have been impacted by the recent LA County fires.


The financial assistance provided through this emergency fund is designed to support individuals and families during their transition as a result of the recent fires in LA County. This funding is intended to help with immediate recovery needs, such as temporary housing costs, basic living expenses, or essential supplies.


These funds are not intended to cover expenses that have or will be covered by insurance.


We are aiming to support as many staff and faculty members who have been impacted as possible. At this time, we are limiting applications related to the LA County fires to one application per Keck Medicine/Keck School of Medicine household. If you submit a second application, you will be added to a waitlist. In the meantime, please check the Fire Resource Page for additional financial assistance resources.


Please be sure to include details about why you are seeking support so the Care for the Caregiver office can properly evaluate your application. As you proceed with your application, please be aware that if the content of your application includes information related to physical, mental, sexual or child abuse, we are required to share the information with the USC Office of Professionalism and Ethics.


If you have questions or need additional support, please call Care for the Caregiver at 323-865-9897.

Are you filling out this form for yourself or on someone else's behalf?*

Please write your own name if you are requesting on someone else's behalf.

Please write your own email address if you are requesting on someone else's behalf.

Please fill in the following fields with your own information.

Please fill in the following fields with your colleague's information.

(med.usc.edu or usc.edu)

Phone

7 digit number that can be found in Workday

Organization:*
Do you work within a Keck Medicine of USC environment?*

Keck Medicine of USC environments: Keck Hospital, Norris Cancer center, USC Care locations, Verdugo Hills, Arcadia Hospital, and Culinary Health Centers in Las Vegas.

Are you applying for this funding because you have been affected by recent LA County fires?*

We are currently only accepting requests for financial assistance that are related to the recent Los Angeles County fires.

We are sorry to hear that you have been impacted. We have some further questions to understand your situation. Please answer the following questions with respect to your primary residence. This can include your primary residence you own outright or one where you have a mortgage or rental obligation.

Did your primary residence that you own outright or one where you have a mortgage or rental obligation experience one of the following?*

What is the address of your affected primary residence ?

CA California
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Did you evacuate?*
  • What has happened to your primary residence?
  • Where are you currently staying?
  • Do you anticipate a change in where you are staying in the next 2+ weeks?


Provide enough detail so that the Care for the Caregiver office can understand the situation.

These funds are not intended to cover expenses that have or will be covered by insurance.


Provide enough detail so that the Care for the Caregiver office can understand how the money will be used in this emergency.

Employee Attestation and Acknowledgement:*

By selecting the button below:


• I understand that I may be asked to provide evidence of the event and its financial impact


• I attest that the information provided on this application is accurate and correct.


• I understand and agree that USC, and the specific organization selected above, have the right to request validation of the information provided on this application at any time.


• I further understand that and if it is determined that the information provided is false or incorrect, any funding being received will cease and the organization reserves the right to exercise discipline up to, and including, termination of my employment.


• If requesting assistance for childcare, I attest that I am the primary caregiver of the children listed above and need assistance in financially funding their child care needs while I continue to perform my work responsibilities onsite/offsite.


• I understand if I am receiving funds from other sources for child care I will be excluded from eligibility for this program.


• I grant permission to USC to share the information I have provided in this application with third party, nonprofit, funding sources who may provide grant funds to USC to support the Caregiver Emergency Fund.

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