(303) 576-2230 info@kodiakbp.com

KODIAK EMPLOYEE ASSISTANCE

COMMITMENT TO OUR EMPLOYEES

CONFIDENTIAL
Kodiak Building Partners Foundation Employee Assistance Fund
COVID-19 Assistance Request Form

[[[["field14","equal_to","American Builders Supply"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","AO Door"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Arizona Wholesale"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Barnsco MI"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Barnsco TX"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Barton Materials"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Builders Alliance"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Builders Millwork Inc"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Christensen Lumber Inc."]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Direct Lumber and Door of Colorado"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Erect A Line"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Factory Builder Stores"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Forest Tek\/Overseas Lumber"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Freedom Materials"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Frontier Building Supply"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Gulf & Basco"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Jenkins Lumber & Hardware"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Jones & Heartz"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Kodiak Building Partners"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Mandere Construction"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Medallion Industries"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","New England Bldg Supply"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Northwest Building Components"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Premier Building Supply"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Specialty Appliance"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Zarsky Lumber Co"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Jenkins Drywall & Insulation"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"],[[["field14","equal_to","Freedom Acoustics"]],[["email_to",null,"kbpfoundation@kodiakbp.com"]],"and"]]
1 Step 1
Personal Information
Full NameAs it appears in our payroll system
Phone Number
AddresssAs it appears in our payroll system
Certification
Under penalties of perjury, I declare that I have examined this application and the related attachments, and to the best of my knowledge and belief, they are true, correct and complete. By my signature below, I confirm that (1) I have read the Kodiak Building Partners Foundation Employee Assistance Fund Grant Procedures (“Employee Assistance Fund Procedures”), (2) I am eligible for a grant from the Employee Assistance Fund (“Employee Assistance Fund”), (3) I agree to the terms of the Employee Assistance Fund Procedures, and (4) I will agree to the terms of my grant under the Employee Assistance Fund.
Signature
Date
date_range
General Information
Are you currently (1) a regular full-time or part-time employee with Kodiak Building Partners or its affiliates, or (2) a temporary employee with at least 5 continuous years of service as a temporary employee with Kodiak Building Partners or its affiliates?
Do you lack the necessities of life, including financial, physical, mental or emotional well beings, as a result of the catastrophic event or emergency hardship that is the basis of this application?
Have you experienced a catastrophic event or emergency hardship that was sudden, unexpected and unusual and resulted in damage to you or your property as described in Section 3(b) of the Employee Assistance Fund Procedures?
Catastrophic Event or Emergency Hardship
A. Please provide a detailed description of the catastrophic event or emergency hardship to be addressed by an Employee Assistance Fund grant. Specifically describe how the catastrophic event or emergency hardship was sudden, unexpected and unusual.
0 /
B. Please provide a detailed description of the necessities of life, including financial, physical, mental or emotional well-being, that you lack as a result of the catastrophic event or emergency hardship described in A.
0 /
C. Requested Employee Assistance Fund grant amount:
D. Are you requesting a one-time Employee Assistance Fund grant?
Requested Employee Assistance Fund grant date
date_range
Are you requesting a one-time Employee Assistance Fund grant?
Amount:
Grant Date
date_range
Amount:
Grant Date
date_range
Amount:
Grant Date
date_range



Note:  The amount of time that the Employee Assistance Fund Committee may take to review a grant application will depend on the event or need that is the subject of the application.

Please attach documentation of the catastrophic event or emergency hardship described in A and B above.  Please also attach support for the Employee Assistance Fund grant amount and timing requested in C and D above.  Documentation should be in the form of evidence produced by third parties and used for other purposes, such as police reports, fire department reports, medical prescriptions, eviction notices, condemnation notices, overdue notices, invoices and other similar documents.



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