Grady Health System provides an Employee Emergency Fund for Grady employees. The fund is maintained through the support of Grady employees and other donations. The Health System and the Grady Health Foundation are dedicated to helping employees in their time of genuine crisis due to unforeseen occurrences in the qualified areas listed below.

Eligibility:
All current full or part-time employees on Grady Health System payroll in good standing are eligible. PRNs who have worked a minimum of 300 hours in the last 90 days will also be eligible. Employment will be verified by Human Resources.

Examples of qualifying CONDITIONS:

Natural disaster (flood, fire, tornado, etc.)
Catastrophic injury or illness of self or immediate family member within the household
Loss of a family member (immediate family - spouse, domestic partner, child, or parent)

Examples of qualifying EXPENSES (all must tie to qualifying conditions):

Funeral or travel costs
Repair/replacement estimates, as applicable
Hotel quote/lodging quotes/receipts, as applicable
Medical bills (see policy for guidelines)

Examples of CONDITIONS that do NOT qualify:

Personal financial management issues
Financial hardships due to the loss of a household income or unexpected divorce
Unexpected home repair issues
Unexpected car repair issues
Credit card debt
Unexpected legal/attorney’s fees
Elective surgery

Examples of EXPENSES that do NOT qualify:

Past-due utility or household bills, past-due mortgage or rent that are NOT associated with a qualifying hardship condition
Automobile repairs, replacements, or payments
Routine medical bills
Education costs

Eligible employees must provide written, valid documentation of conditions and expenses.

Full Name:*

First Middle Last

Employee ID:*

Hire Date:*

Contact Phone Number:*

Current Mailing Address:*

If a grant should be approved, you will receive a check by postal mail. Please provide your current mailing address below.

Street Address Address Line 2 City State ZIP Code

Email Address:*

Please check which of these approved areas your financial emergency qualifies and for which you are able to document financial need:*

Natural Disaster (flood, tornado, etc.)
Fire
Catastrophic Injury or Illness
Loss of a Family Member (spouse, domestic partner, child, or parent)
COVID-19

Have you applied to the Employee Emergency Fund before? If yes, when and what was the reason?

Specific Condition Causing Hardship:*

All supporting documentation such as funeral notices, police reports, doctors' notes, must be attached and can be verified.

Specific Expenses Associated with the Hardship:

All supporting documentation such as receipts, bills, and/or estimates must be attached and can be verified.

Total Amount Requested:*

The maximum assistance an eligible employee may receive is up to $1,000 or 5% of their annual pay, whichever amount is less, during any 12 month period. Eligible employees are encouraged to use the Employee Assistance Program (EAP) (GHS Policy #300.05/EAP) to prepare to use the resources of this program in the best way. EAP is Grady's source for confidential connection to resources for personal challenges of any magnitude.

Please enter a number from 0 to 1000.

Authorize Review:*

Submission of this form authorizes Grady Human Resources to contact and verify the source of the hardship.

Yes, I agree.

Support Documents:*

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Accepted file types: jpg, pdf, Max. file size: 20 MB, Max. files: 3.