Lighthouse of Hope Fund - Application

Applicant Information
Provider Information
Experience Information

Participants in the Experience (spouse, children, caregiver, etc.)

I certify that the applicant has a life expectancy of less than twelve months and has no other means by which to fund this experience.  I have discussed this experience with the applicant and have deemed it safe and reasonable that his/her experience is granted. 

I acknowledge that any funds not used for this specific experience, used for unapproved costs, or cannot be accounted for in receipts must be returned to NHF. Financial reporting must be submitted within one month after the experience occurs. I understand that if I do not comply with these financial reporting requirements that my hospice organization will no longer be eligible to receive grants from the Lighthouse of Hope Fund.

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