Staff Assembly Assistance Request Form

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The Staff Assembly Assistance Committee tries to provide assistance to UCR staff members needing support. Please complete this form and return it to the Staff Assembly Assistance Committee Chairperson. All requests for assistance are kept confidential. Staff assembly will only assist in the form of gas and/or grocery store gift cards. These gift cards should be used to offset the cost of the actual area of assistance need.
 
Eligibility Requirements
Any UCR career appointment status employee is eligible to request assistance. The staff member must have completed the probationary period. A valid employee identification number is required.
 
All requests for assistance must fall under the guidelines of the UCR Catastrophic Leave Program. For information about the UCR Catastrophic Leave Program guidelines, please go to the following website:
 
   
Limitations on Assistance
Staff assistance is provided in the form of gas and/or grocery store gift cards. Direct cash assistance is not provided through this program. The maximum amount of assistance is limited to a value of up to $100 per employee, per fiscal year (July 1 to June 30).
1. Please provide the following information:
4. Have you requested assistance for Staff Assembly in the past? *This question is required.