Victim’s Fund Application

Apply for the Victim’s Fund. Please complete the following form to apply to receive support from the Victim’s fund.

    * Required

    Did family member pass away in accident?
    Is there a Police Report?
    Health Insurance?
    Did they cover all of the treatment?
    Is there a balance?
    Is there an open bodily injury case?
    Did case settle?
    Did at-fault party have insurance?
    Do you have Uninsured or Underinsured motorist coverage?
    Do you have med-pay?
    Are you represented by an attorney in connection with this injury?
    Are you seeking or interested in legal representation for this injury?

    Up to 3 photos, 6 MB each. Have more? We can collect them after form submission.