To receive a Hospital Help Program grant via Venmo, please complete the form below. All fields in the application form are required. Venmo uses the payee’s phone number to verify that the payment is going to the right person. We use the email to let the payee know when the payment has been initiated.
Return to the Hospital Help Program page if you want to select a different payment option. You can also view the grant eligibility criteria on that page.
The completed application form will be emailed to [email protected]. The payee will receive an email from that address to confirm the status of your application. The payee may also receive an email requesting clarification of information in your application.