• The DOMINION FOUNDATION
    for Christian Science Nursing, Inc.

  • Application for financial assistance with
    Unpaid Christian Science Nursing Invoices

  • We ask that you please apply to the National Fund for Christian Science Nursing at nfcsn.org. before applying to the Dominion Foundation. Have you applied to the National Fund?*
  • We provide grants for unpaid Christian Science nursing invoices. Do you have unpaid invoices after receiving Christian Science nursing care in the home?*

  • If you answered “Yes” to these questions, you may qualify for a grant. Please complete the application fully to enable us to process your request. All information you provide will be kept strictly confidential.

  • Format: (000) 000-0000.
  • Rows
  • Rows
  • Rows
  • Rows
  • After insurance benefits have been fully utilized, The Dominion Foundation for Christian Science Nursing, Inc., will consider payment of the remaining expenses for Christian Science home nursing care. This includes insurance deductibles. Do you have health or disability insurance or other sources of financial assistance that would cover part of the costs of the Christian Science nursing?*
  • May we have permission to contact other funding organizations that you have applied to?*
  • Please submit unpaid invoices from the Christian Science nurse with this application or mail them to The Dominion Foundation for Christian Science Nursing, Inc. at the address on page 1.   Christian Science nursing invoices should include hourly or daily charges, travel expenses, and supplies and equipment needed to provide care. Valid receipts are required for travel expenses, supplies, and equipment.  Invoices should also list all payments from other sources and any patient contribution.
  • Browse Files
    Cancelof
  • Browse Files
    Cancelof
  • Browse Files
    Cancelof

  • By providing my signature below, I affirm that all information provided on this form is accurate.

  • Date*
     / /

  • Applications and invoices are reviewed on a monthly basis by the Trustees. You will be notified shortly after
    the monthly meeting.

    Applicants receiving grants will be mailed a check made out to the Christian Science nurse. All communication regarding the grant will be with the applicant, not the Christian Science nurse.

  • Should be Empty: