Apply for a Grant

Only QCS Members, a surviving spouse or dependent are eligible to apply for a grant. All inquires are confidential. 

Please enter the full legal name of the person making this request.: *
Is the member deceased?: *
Yes
No
The person making this grant request is:: *
I am a Quarter-Century Society Member
I am the surviving spouse of a Quarter-Century Society Member
I am a surviving dependent of a Quarter-Century Society Member
Enter the full address for the person requesting the grant. Street Address, City, State, Zip Code: *
Phone number : *
Email address : *
Is the member:: *
No longer working at International Paper.
Active employee at International Paper.
International Paper location where the member works (worked). Please provide IP location name, City and State: *
What is the reason for this grant request? Note that documentation is required. A copy of a bill, repair estimates or insurance claim will be requested to validate your request. The issue must be less than 6 months old.: *
Unpaid Medical Expenses
Unpaid Dental Expenses
Funeral Expenses
Unpaid Utility Bill(s)
Home repairs
Household modification due to disability
Other
Briefly describe the specific serious or urgent financial issue that is causing you to apply for this grant.: *
Enter the amount you are requesting.: *
Have you ever received a grant from the Quarter-Century Society in the past?: *
Yes
No
Have you applied for assistance from any other group or agency?: *
Yes
No
Are any of the following involved in the paying for all or a portion of the expenses in your request? (check all that apply): *
Medical Insurance
Dental Insurance
Homeowners Insurance
Auto Insurance
Workmans Compensation
Legal Action / Settlement
Other
None of the above
(Optional) Additional Comments: