Health Care Assistance Grant Application

In addition to funding meaningful impact health care initiatives for individuals, For Those Who Would periodically offers health care assistant grants selected through an open application process. Grant recipients are selected by representatives of our board of directors. The two primary criteria used to select recipients is the fit within the mission of our organization and the impact that the grants will have on the individual’s life.

As with all of our initiatives, we maintain confidentiality and privacy to the extent allowed by law. See our privacy promise for further details.

Healthcare Assistance Application

Your Name*
Your Phone Number*
Your Email Address*
Name of the person to be supported by this grant*
Describe the illness or injury for which the health care grant would be used*
Describe exactly what funds from this healthcare grant would be used for*
Describe the impact this grant would have on the life of the recipient and/or their family.*
If selected to receive this grant, I understand that I may need to produce documentation that verifies appropriate use of funds.*
- Yes, I understand that documentation may be required to verify that funds from this grant will be used appropriately