Hole In One Foundation Donation Request
Name (Person submitting application)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Date
-
Month
-
Day
Year
Date
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Name (Person in need of assistance)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
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Employment
*
Currently employed
Employed but currently unable to work due to medical reasons
Unemployed
Disabled
Retired
Self
Other
Please explain in detail the major life-changing event that has caused the incurred financial burden.
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What costs have been or will be covered by insurance?
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What costs will not be covered by insurance? How much is your yealy deductable?
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Type of assistance you're in need of (ex. monetary donation, gas cards, food, clothing, etc.) Please explain in detail how the donation will be used .
*
Have you received any other donations? Has the Hole in One Foundation Dontated to this person previously? How did you hear about the Hole in One Foundation?
*
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Has there been a benefit held for this cause and if so, what is the total of monetary donations received? (include all bank accounts, online funding sites ex. gofundme, local benefits, all money raised for cause)
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