Request Assistance

Apply for support from the Family Assistance Program

Assistance Request Form

If your family has been affected by impaired driving and you need support, we're here to help. Please complete this form and our Foundation committee will review your request with compassion and care.

Contact Information

Family Information

Confidentiality: All information provided is kept strictly confidential and is only reviewed by our Foundation committee.

Questions? Contact us at assistance@reedrohlmanfoundation.org