Are you or someone you know in crisis?
Hope Assistance Application
Thank you so much for applying for assistance from Hope Charities. We exist to help patients who are suffering through crisis caused by a bleeding disorder! We consider it our honor to try to help you through this difficult season. Hope Charities strives to be a conduit of hope, strength, and resources to patients and their families who are suffering through crisis.
Your personal information is of the upmost importance to us and will be kept strictly confidential. By completing this application, you are giving Hope Charities permission to communicate with you about your application and send you information regarding and future events and education materials.
We ask that you please fill out this form completely. We need all the information requested so please don’t ignore any of the blanks, unless it does not apply (i.e.: 2nd parent/guardian).
We cannot process your application until we receive all supporting documents.
What can you expect?
Thank you for applying to become a recipient of hope! We will honor your time by having one of our team members carefully evaluate your application in person. We will take into consideration ALL of the information you have supplied and may request further information if needed.
If you have questions you may contact us anytime at [email protected] or by calling 888-529-8023.
Thank you for giving us the opportunity to serve you and your family through this very difficult
season!
Sincerely,
Hope Charities Team
Your personal information is of the upmost importance to us and will be kept strictly confidential. By completing this application, you are giving Hope Charities permission to communicate with you about your application and send you information regarding and future events and education materials.
We ask that you please fill out this form completely. We need all the information requested so please don’t ignore any of the blanks, unless it does not apply (i.e.: 2nd parent/guardian).
We cannot process your application until we receive all supporting documents.
What can you expect?
- A volunteer committee evaluates ALL applications based on type of need, amount of assistance requested, and state of crisis. We do not discriminate on the basis of age, race, sexual orientation, gender, or religion.
- A Hope Charities team member will contact you by phone within two business days after receipt of your application.
- Applications can take up to 2-4 weeks to obtain a decision by the review committee.
Thank you for applying to become a recipient of hope! We will honor your time by having one of our team members carefully evaluate your application in person. We will take into consideration ALL of the information you have supplied and may request further information if needed.
If you have questions you may contact us anytime at [email protected] or by calling 888-529-8023.
Thank you for giving us the opportunity to serve you and your family through this very difficult
season!
Sincerely,
Hope Charities Team
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Qualified Referral Form
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