East Side Teachers Association

Relief Fund Application

The ESTA Relief Fund was launched in the fall of 2007as a means of assisting ESTA members who suffer unreimbursed financial loss of valuable personal property caused by either theft, vandalism, natural disaster, or fire at their worksites or while engaged in ESTA business.

Any application to the ESTA Relief Fund must be preceded by the filing of a police report with the San Jose Police Department. For many crimes against property, citizens can file police reports online. See https://www.sjpd.org/trac/ for details.

Please read the two paragraphs on the reverse side of this application form, which refer to current policies of the ESTA Relief Fund as approved by the ESTA Assembly.

Name ______________________________ Site __________ Date ____________

Date of loss_____________ Police Report number _____________ (attach copy)

Amount you are requesting from the ESTA Relief Fund: $__________________

Please describe the nature of your loss, with a brief description and value for each item.

Item value to location at owner? proof of

______________ replace time of loss _______ purchase?

Do you have insurance that covers some or all of this loss? q yes qno

If “yes”, briefly state the reason why you will not receive the full amount of the loss from your insurance.

Please provide a brief narrative to describe the loss. Continue on reverse side or use a separate paper if needed. It may help to refer to the list on the reverse side of the application entitled “Factors which may contribute to a favorable ruling of the Relief Fund Committee”.

Factors which may contribute to a favorable finding of the Relief Fund Committee include:

• the applicant took prudent measures to safeguard the lost property prior to the loss;
• the property was damaged or stolen at such time as the member was engaged in attempting to suppress student violence;
• the District refuses to reimburse the member;
• the applicant has no personal property insurance to cover the loss, or would suffer financially by submitting an insurance claim;
• the lost or damaged property was so important that the member was required to immediately replace it;
• the property loss occurred on, or immediately adjacent to, District property, or while the member was engaged in ESTA business.

Factors which may contribute to an unfavorable finding of the Relief Fund Committee include:

• the applicant took inadequate prudent preventive measures to safeguard the property;
• the lost or damaged property was District property;
• the Relief Fund has a balance that cannot support this request;
• the lost property was inappropriately brought to the worksite;
• there is evidence of fraud or dishonesty on the part of the applicant;
• the loss is cash, a cell phone, or a personal entertainment device;
• the loss was to the member’s stationary automobile and does not affect the safe operation thereof;
• the loss occurred away from the worksite, or to the member’s moving automobile;
• the loss occurred at a time prior to the creation of the ESTA Relief Fund.