Helping Hands Fund Application
Helping Hands Fund
Providing up to $500 per year in emergency financial assistance for team members in times of personal hardship. Request will be sent confidentially to the Hillcrest Helping Hands Committee for review.
Full Name
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Primary Service Line
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Please Select
Hillcrest Millard
Hillcrest Health & Rehab
Hillcrest Shadow Lake
Hillcrest Country Estates (cottages)
Hillcrest Grand Lodge
Hillcrest Mable Rose
Hillcrest Highlands of Gretna
Hillcrest Silver Ridge
Hillcrest Firethorn
Hillcrest Caring Companions
Hillcrest Home & Community Services
Innovate Physcial Therapy
Innovate Rehab & Wellness
Phone Number (personal/cell)
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Email Address (personal)
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Assistance Request (check all that apply)
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Rent/Mortgage Assistance for eviction
Utility Shut Off (electric, water, gas etc.)
Funeral Expenses
Transportation Needs (repairs, etc.)
Temporary Housing
Other
Amount of Assistance Requested (Up to $500)
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Situation Summary: Please describe the circumstances that led to this financial need. Include as much detail as possible, including dates, and causes.
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How will this assistance help you recover from this hardship?
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Please attach all supporting documents such as: bills/invoices, lease or mortgage documents, medical bills or proof of emergency, police or fire reports, any other documentation related to the request.
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What other community resources or financial aid have you applied for to help in this situation? What was the outcome of these requests?
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Acknowledgement and Authorization: I understand that the Helping Hands Fund is intended to provide short-term emergency assistance to Hillcrest team members experiencing hardship. I certify that the information provided is accurate and complete to the best of my knowledge. I authorize the review committee to verify the information provided, and I understand that submission of this application does not guarantee approval or payment.
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