Emergency Relief Fund Grant Application

Our emergency financial assistance program, the Emergency Relief Fund, provides critical financial assistance to Oasis Hospice & Palliative Care, Inc. patients and their families requesting immediate short-term relief for an emergency. When the funds are not currently accepting Requests for Proposals, we quickly provide funding on a person’s behalf for emergency cases concerning our Education, Wellbeing, Transportation, Funeral, Community, and Heart’s Desires funds.

Due to limited resources, the Oasis Foundation cannot accommodate your request if you are not an Oasis Hospice & Palliative Care, Inc. patient or a patient’s family member.

First Name

Last Name

Date of Birth

Email Address

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

The following questions on gender, age, and ethnicity are not required but are highly encouraged to answer. Your response will not affect your application but will help us identify what community members are utilizing our resources.

What is the amount you are requesting?

When do you need the grant?

Describe how you will use the grant. Please provide as much detail as possible.

Thanks for submitting!

Emergency Relief Fund Grant Application

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