Employee Hardship Loan Application

The Hardship Program provides eligible employees with a loan of up to $1,000, which is repaid with interest over 13 pay periods. Please review the full Hardship Program policy on DocTract on the Intranet (Policy 4.10.005). To be eligible, an employee must be experiencing an unanticipated family emergency, such as a medical crisis or the loss of transportation, housing, or utilities. Additionally, employees must be classified as permanent full-time or part-time staff, have completed at least six consecutive months of service, and have no corrective actions on record within the past 12 months. Only one hardship loan may be active at any given time.

Job Status
I have read and understand the policy for the Employee Hardship Loan.(Required)
I certify that all information contained in this application is true, correct and falsification of information may result in denial and/or corrective action.(Required)
I understand that if I leave Cheyenne Regional employment prior to the end of my repayment period, I will repay Cheyenne Regional the remaining balance of my Employee Hardship Loan from my final paycheck. If there are not sufficient funds to pay my remaining balance, I agree that I will be billed for the balance owed.(Required)
I understand there is a repayment requirement and that I will be required to sign the Employee Hardship Loan Contract.(Required)
I understand that this is not a contract of employment, and that all employment with Cheyenne Regional is voluntary and at-will, meaning that I or Cheyenne Regional have the right to terminate the employment relationship at any time, for any reason or no reason, and that this agreement does not alter that at-will employment relationship.(Required)
I understand that Cheyenne Regional reserves the right to amend or terminate the offering of the Employee Hardship Loan, at any time.(Required)
I am in good standing and not currently on corrective action.(Required)
I do not currently have an Employee Hardship Loan.(Required)
I understand that I may be eligible to apply for an additional Employee Hardship Loan only after my previous loan is paid in full and I provide documentation demonstrating participation in financial wellness activities (such as EAP financial coaching, meetings with banking partners or financial literacy seminars).(Required)

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