Associate Hardship Fund Application


Benevolent Funds

Benevolent Fund for Associate Hardship : Application Instructions

Upstream’s Benevolent Fund for Associate Hardship was  created to assist Upstream associates, their spouses and/or eligible dependents who are facing financial hardship because of a qualified incident. Applications will be reviewed by the Benevolent Fund for Employee Hardship Grant Advisory Committee. All applications will be treated confidentially. If the application is approved, the Benevolent Fund for Associate Hardship will issue funds in the form of check(s) payable to the vendor(s) to which the associate owes payment(s), or the Fund will reimburse the associate directly if a paid receipt is provided as documentation.


Associates under any employment status of Upstream are eligible to receive grants as follows:

  • Full or regular part-time associates (24 hours/week) actively employed or under any employment status by Upstream Rehabilitation
  • Six or more months of continuous service
  • No disciplinary or performance warnings for the 6-month period prior to the application
  • Have experienced a qualifying incident within the past 90 days

Qualifying Incident

The following are the criteria for an incident to be qualified as a reason for a grant:

  • One-time event outside the employee's control such as sickness/medical emergency, accident, loss of housing, catastrophe, personal tragedy, natural disaster
  • Unexpected and unforeseeable
  • Directly affects the associate financially
  • Have exhausted/is utilizing other means of funding (insurance, savings, social services, etc)
  • Must use the money for housing, utilities, food, transportation, child care, or similar necessities for which money is not available due to the incident
  • The grant is not to cover the impact of loss of income due to a cutback in hours or unemployment, unrelated credit card debt, home foreclosure, accumulated financial distress, or failure to plan. In the case of declared national or state emergencies or disasters exemptions to this criteria will be considered.

Application Process

To submit an application, an eligible associate should:

  • Contact the fund administrator to discuss the associate’s eligibility and determine whether the incident is likely to qualify the associate to receive a grant
  • Submit a complete application within 90 days of the incident
  • Certify that the application is true and accurate


Grants are made upon the recommendation of the Benevolent Fund for Associate Hardship Advisory Committee as follows:

  • Grant limit: typically $1,000. Grants are limited to a cumulative amount of $3,500 in a 365 day period.
  • Grants are made by check from the fund and are typically payable directly to the vendor (landlord, utility company, or other vendor).
  • Grants are typically awarded to help pay expenses or bills directly related to the qualified incident as defined These expenses could include, but are not limited to, medical expenses not eligible for reimbursement by insurance, housing (rent, mortgage, security deposit), utilities (water, gas, electric), food, transportation, child care, or other essentials.
  • Invoices and receipts are required to receive reimbursement through grant funds.

In the case of a denied application, the applicant will be eligible to submit a new application as determined by the grant advisory committee.

Applications will not be considered until they are complete. Applications must be submitted within 90 days of the qualifying incident. You may submit an application online by submitting this form and uploading necessary documents or by mailing in your application and copies of necessary documents. 

  • Application Form

    Please complete all parts of the application below and submit with signed certification and all required documents. An electronic signature is considered your attestation of certification.
  • Note: must be at least six months
  • MM slash DD slash YYYY
  • Required Documents

  • Company owedAddress of companyEssential need providedAmount OwedDate DueName of ApplicantDate 
    Examples of Essential needs are: rent, electric, medical, transportation, childcare, etc. Press the + sign to add additional bills / utilities
  • Drop files here or
    Max. file size: 32 MB.
      Upload Copies of current bills/invoices for which grant is requested Other documents to substantiate the current amounts owed as listed above If requesting reimbursements for previously purchased items, to help you meet basic standard of living, receipt of payment for those necessities are required. Dates of purchase must be legible.
    • Associate Certification Statement

      Due to an incident outside of my control, I am in need of financial support to meet my immediate obligations. By signing this application, I certify that all of the information contained in this application is true and correct. I authorize the Benevolent Fund for Associate Hardship Advisory Committee to obtain and/or verify all information necessary to process this application. Additionally, I understand that no associate is automatically entitled to receive a grant, either by their employment or because of any precedent inferred from a previously approved grant. I understand grants will not be made before an associate has demonstrated an immediate need.
    • Type your Legal Name
    • MM slash DD slash YYYY

    If you have any difficulty completing this application online, you can download a printable copy of the application below and submit via mail.

    Associate Hardship Fund Instructions and Application

    Send the completed application with requested documentation to:

     Benevolent Fund for Associate Hardship
    Attn: Robbe Bendick
    8205 President’s Drive
    Hummelstown, PA  17036 

    Or scan and email materials to