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SARH Employee Assistance Fund

SARH Employees

SARH Employee Assistance Fund

SARH Employee Assistance Fund Application

The reviewing committee does not know your identity, but only your situation. The hospital CFO is the only person who receives your completed and full application with your name on it. The application is blinded for committee members. Because your unexpected circumstances may in some cases reveal who you are, additionally, committee members have signed a confidentiality pledge. You must provide as much information as possible for the committee to make their decision. Complete EVERY section of this form for it to be reviewed by the committee. Please upload bills, quotes, invoices, etc to your application. Applications will not be considered without information regarding the direct payment. Funds are NOT distributed directly to employees.

Funds are housed at the SARH Foundation and are provided by generous donations from employees and others in the community.

Contact Information
Month
/
Day
/
Year
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Household Information
Reason for Applying
Total Amount Requested
Breakdown of Funds Requested

To expedite your request, a breakdown in funding is needed. Provide the total of each item along with the vendor to be paid. Be sure the sum of your item(s) equals the total amount requested. Upload attachments for each item such as bills, quotes, invoices, etc. Your application may be returned to you and not considered without information regarding direct payments of funds requested.

Item 1
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Item 2
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Item 3
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Additional items
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