Application of Gift

This is an application to receive aid or relief, monetarily or otherwise, created by Vigilant Watch. This charitable relief will provide support to our Regional first responder public safety officials (Police, Fire, Sheriff’s Dept., and EMS), active, retired and their immediate families, (herein called PSO), without regard to Race, Color, Creed, Religious affiliation, familiar status, handicap, or sexual orientation, whether in the line of duty or not, who have suffered a hardship based on an injury, illness, or catastrophic event which has created a financial or physical hardship.

Currently, applications for aid or relief from residents of the Hampton Roads and Eastern Shore of Virginia areas are being accepted.

Vigilant Watch, Inc. has a non-profit status under Section 501 (c)(3) of the Internal Revenue Code. This application must be completed in accordance with the instructions to the Vigilant Watch Application of Gift instructions. The full list of instructions can be viewed here.

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All fields listed with an * are required.
Relationship of Applicant to PSO
Address of Applicant
Address of Applicant
City
State/Province
Zip/Postal
Status of PSO with Department
PSO/Recipient's Address if different from Applicant's Address
PSO/Recipient's Address if different from Applicant's Address
City
State/Province
Zip/Postal

Public Safety Official's Dependents

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Verification of Medical Condition or Catastrophic Event :
In order to process your request for assistance, we require a doctor’s verification of your stated condition(s). We recognize that it is sometimes difficult to obtain such information from treating providers. Please do the best you can to gather these details so that we can be in an ideal position to assist you. (See instructions page for information required.)
Is money needed?
$
Would volunteer help benefit you?
The undersigned affirms that the information provided in this Application is true, correct and complete. By executing this Application, the undersigned agrees to be interviewed by Vigilant Watch, Inc Executive Board if it, in its discretion, so desires. The undersigned’s failure to submit to an interview after request therefore shall automatically suspend the evaluation of this Application and preclude the making of any distributions hereunder. The undersigned agrees that Vigilant Watch, Inc. and its executive board shall have no obligation to make any distributions hereunder or pursuant hereto, whether to the applicant or recipient designated herein or otherwise. Moreover, Vigilant Watch, Inc. and its executive board shall have no liability to the undersigned or any person or entity contemplated by this Application under any circumstance whatsoever. The undersigned understands that all information shall be kept confidential by Vigilant Watch, Inc. and its executive board except: (a) as may be required pursuant to a valid court order, (b) to counsel, (c) in connection with the preparation of tax returns or other required financial disclosure, (d) pursuant to any inquiry from a governmental or quasi-governmental entity that has jurisdiction over Vigilant Watch, Inc. or (e) as needed to evaluate the request for assistance or (f) as otherwise required by law.