Initiating the Process

A person of need must be nominated by another individual who knows of their struggle. The “Nominator” submits a Nomination form on behalf of the person of need.

The Role of the Nominator

Considering nominating someone for assistance is the first step to delivering comfort and aid to that person or family.

The Empire Area Community Emergency Fund is designed to assist people who are usually solvent but for some unforeseen circumstances are experiencing difficulties in paying their bills. These people would likely never ask for help and need someone else to recognize their need.

If you choose to become a Nominator you may experience some awkwardness that comes with approaching people that you believe may be struggling. You may have to ask them to share details about their lives regarding their health, employment and finances and ultimately they’ll have to provide you with copies of outstanding bills that you will submit to the Emergency Fund Committee along with the completed Nominator form.

The Nominator plays a vital role and may become a lifeline to the individual or family who is suffering. The Nominator helps connect the family or person in need with potential resources that they never knew existed and in doing so demonstrate care and compassion for them.

This program offers anonymity to the individual or family. Their identity is never revealed to the public thereby honoring their privacy and preserving their dignity.

The Nomination Form

To view a printable page of only the nomination form click HERE
(zoom out so that the form 100% visible in your browser page)

The Nomination form is shown below.


This Dropbox button will display the registration form to you in a new window.  You can print it directly from there or save it to your local storage using the download command in the menu in the upper right hand corner.

Not all browsers and devices behave the same. If you have trouble getting a single page printout of the Nominator form, then email a request to our Emergency Fund Chairperson at