Beneficiary Form – Carnegie Hero Fund Commission

“To place those following peaceful vocations, who have been injured in heroic effort to save human life, in somewhat better positions pecuniarily than before, until again able to work. In the case of death, the widow and children, or other dependants, to be provided for until she remarries, and the children until they reach a self-supporting age.” — Carnegie Hero Fund Deed of Trust

First-time applicants

To apply for financial assistance with living expenses for the first time, please download and complete this form.

DOWNLOAD APPLICATION

All applications should be sent by e-mail to carnegiehero@carnegiehero.org or postal mail at Carnegie Hero Fund Commission, Attn: Jo Braun, 436 7th Ave., Suite 1101, Pittsburgh, PA 15219-1841.

Ongoing beneficiaries

Ongoing beneficiaries will be contacted by mail for renewal, and should complete the mailed form and include 1) a copy of their most recent income tax returns; 2) copy of most recent W2s, if working; and 3) a copy of the Social Security Administration’s most recent correspondence in which the Social Security benefit(s) is stated, if receiving Social Security payments.

If the mailed information has been lost or payments have stopped inexplicably, please complete the form below.

Beneficiary First Name*
Beneficiary Last Name*
Awardee Name*
Case Number
Best way to contact:*
Phone
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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