Funeral Expense Application

Funeral Expense Application

This application is directed to those who have lost a child. (1 day old to 18 years of age). This gift, if awarded will be distributed directly to the funeral home.
In the midst of overwhelming grief, families are often faced with unexpected financial burdens that can add even more stress during an already devastating time. At the Luke Alan Foundation, we believe parents should have the space to grieve, remember, and honor their child without the added weight of funeral expenses. Through compassionate support and financial assistance, our mission is to help ease that burden and remind families that they are not alone as they walk through one of life’s most difficult journeys.
Applicant Full Name

First NameLast Name
Applicant Email Address
example@example.com
Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Child's Full Name

First NameLast Name
Date of Child's Passing

MonthDayYear
Date
Age of Child
Funeral Home Name
Funeral Home Contact Person
Funeral Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Funeral Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Upload Funeral Home Invoice or Documentation

Cancelof
Additional Comments or Information
Should be Empty: