Please read the following important information carefully before completing this form:
REASON FOR HARDSHIP REQUEST
I hereby request assistance in accordance with the MLBA Application for Assistance Guidelines. I am an Alorica employee in good standing or have attached a written recommendation from my Alorica sponsor and the appropriate documentation (if required) as proof for my assistance request.
PARTICIPANT CERTIFICATION, ACKNOWLEDGMENT AND AGREEMENT
I certify that the information and supporting documentation that I have provided is complete and accurate. I have read and agree to the MLBA Application for Assistance Guidelines. I certify that if funds are requested, the amount of distribution requested above is not in excess of the amount necessary to satisfy the financial need described above, and that I have previously obtained all distributions and non-taxable loans available to me. I agree to provide the MLBA Administrator with evidence of the existence of the financial need and the amount necessary and other documentation requested to satisfy such need upon request.
I understand that the MLBA Chapter Board (if any) and/or the MLBA Executive Board will review my application and will determine whether I qualify for the amount requested. I understand that failure to provide complete and accurate information may disqualify me from receiving any funding.