Warning: A non-numeric value encountered in /home/thecompassionfun/public_html/wp-content/themes/Divi/functions.php on line 5607

Compassion Fund Application

  • Advocate Information

    All Applications must have an Advocate to assist in the process and be the point of contact for the Applicant. Usually the Advocate will be the Chaplain or Human Resources Director.
  • Facility Information

    Please identify with which Signature HealthCARE Facility/Community the Applicant is associated.
  • If Applicant is a current SHC Stakeholder

  • Compassion Fund Criteria

  • Circumstances of Hardship

    Please describe the circumstances which you believe demonstrate eligibility for relief assistance. Please describe fully the TRIGGERING EVENT of your situation, especially as related to the criteria described on page 3.
  • Details

    Please completely fill in the form below with information on each specific item where you are requesting assistance. All items should be listed for which help is being requested and a copy of all corresponding backup for each item should be attached.
  • Name and/or Type of Help RequestedExplanation of Help RequestedBill or Estimate Attached?Amount of Requested Help 
    Add a new row
  • Documentation

    Please enclose ALL of the following requested items and check below those that are being provided as attachments to this application. If there is a compelling reason that a requested item cannot be provided, please indicate such in the appropriate space. FAILURE TO PROVIDE THE REQUESTED DOCUMENTATION, EVEN FOR A STATED REASON, MAY RESULT IN A DELAY OF PROCESSING OR A DENIAL OF AWARD.
  • REQUIRED ATTACHMENTS‐ (Please indicate below those attached)

  • Drop files here or
  • Drop files here or
  • Drop files here or
  • Advocate Testimony

    Advocates (or other references the Applicant may wish to provide) should provide a brief explanation of why they believe the Applicant be considered for an award of funds as well as any other information they consider pertinent to the request. If the person referring the applicant is someone other than the Advocate, please provide their names and contact information along with the recommendation. Feel free to attach testimonies below.
  • Drop files here or
  • Required Signatures

    I, the undersigned, have examined this application for assistance and certify the claim to be valid and that all the answers and information are all true and correct and that the request for emergency assistance is necessary and the Applicant has exhausted all other resources available for assistance
  • The Compassion Fund reserves the right to limit award amounts as necessary in order to be good stewards of our limited funds so as to be able to assist as many applicants as possible. Applicants who are now (or who once were) Signature Stakeholders must be considered employees in good standing (either now or at the time when they left) in order to be eligible for assistance from the Compassion Fund. This requirement also applies to immediate family members of current or former stakeholders as well. PLEASE NOTE: All information provided must be current and accurate. Fraudulent applications will result in denial of your application and may result in administrative action and/ or legal action as well.