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"I was out recovering for over a year with surgeries and physical therapy and was overwhelmed by your generosity and thoughtfulness. I am now back to full duty with my Department and a member of the 100 Club." - David Lewis -- Tucson Police Department

Safety Enhancement Stipened (SES) Application

To apply for a Safety Enhancement Stipened, fill out the following form completely.

Department/Agency:
Amount of request:
Date of Request:
Date When Needed:
Specific need you are requested stipend for:

Reason such item(s) cannot be provided for in your normal operating budget:

Are there any other sources of funding that were considered and why could they not be used?

Studies undertaken by your department or others that would indicate that such item(s) would enhance the personal safety of officers/firefighters:

Additional information may be requested by the committee in support of the stipend. Submissions and attachments become the property of the 100 Club and cannot be returned.
Contact person making request:
First Name:*
Last Name:*
Title/Position:
Complete mailing address:
City:
Zip code:
Phone Number:
Fax Number:
Email Address:
* If the contact person is not the department/agency head, please include the agency head’s name and contact information on an attachment and a signed statement that they support the application. All award notifications will be sent directly to the agency head.
You will need to submit two recent quotes to the 100 club. If two recent quotes cannot be provided, you will need to submit a letter explaining why they cannot be provided. Upon receipt of your quotes or letter, the 100 Club office can proceed with the review of your application.

When you click the button below your application will be emailed to the 100 Club Office.