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Impact Advocacy Program
GUIDE
Understanding Grief
Caring for Loved Ones Experiencing Loss
Grants for Families
Essential Needs Grant
Grief Counseling Grant
Childhood Bereavement
Application for Aid
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Life Interrupted Foundation
Application for Aid
First name
*
Last name
*
Email
*
Phone
*
Address
*
Birth Date of Applicant
*
Month
Day
Year
What kind of help are you looking to receive?
*
Resources (i.e. support groups, lawyers, counselors, etc)
Essential Needs Grant
Grief Counseling Grant
Childhood Bereavement Scholarship
Date of Loss
*
Month
Day
Year
Describe the Nature of the Loss
*
How will a Grant be used to help your situation?
*
Did you recieve any benefits (i.e. Life Insurance, 401k, etc) following the loss
*
Yes
No
Was the loss unexpected and/or sudden?
*
Yes
No
Death Certificate
Upload File
Most Recent Tax Return
Upload File
3 Most Recent Bank Statements
Upload File
Bills and/or Expenses
Upload File
Do you agree to a background check if conditionally approved for grant funding?
*
Yes
No
Signature
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Submit
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