Skip survey header

Application for the Worker Organizer Protection Fund

WORKER’S BASELINE INFORMATION

Disclaimer: Only workers who were wrongfully fired for organizing can take this survey.

Funding will be distributed for all entries that are fully completed and judged to be genuine while funds are available.

The Fired Up Coalition does not and shall not discriminate based on race, color, religion, gender, gender expression, age, national origin, immigration status,  disability, marital status, sexual orientation, or military status in any of its activities or operations.

1. Contact Information *This question is required.
2. Are you filling out this form for yourself? *This question is required.