RECIPIENT APPLICATION

The St. Nicholas Neighbor in Need Foundation is committed to helping individuals who struggle with life difficulties due to a handicap, disability, long-term illness, accident, or other quality of life difficulty. To become a candidate to be considered as a recipient of the St. Nicholas Neighbor in Need Foundation or to refer someone else to be considered a recipient, please fill out the below application.

Typically one person will be selected each year to be the recipient of the St. Nicholas Neighbor in Need Foundation. We rely entirely on where the Holy Spirit leads us and if funds allow may be able to grant more than one.

Are you filling out this application for yourself or someone else?

Self

Someone Else

If filling out application for someone else please input your name, address, phone number and email address in the box below. Also, please indicate how you are related to or know the individual you are referring.

Applicant Name

First Name

Last Name

Applicant Date of Birth

YYYY

Applicant Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Please tell us why you or the person you are recommending should be considered as a St. Nicholas Neighbor in Need Recipient.

Have you, or the person you are recommending, previously received assistance from the St. Nicholas Neighbor in Need Foundation or any other granting organization?

Medical Information:

Handicap or Disability

Long-term Illness

Accident

Other (Please tell us more information below)

If HANDICAP, DISABILITY OR LONG-TERM ILLNESS please list Primary Diagnosis and Date of Diagnosis

Date of Accident

YYYY

If ACCIDENT, please state resulting details and medical situation.

OTHER....Please give us as much information as possible about your situation.

As part of the application process we require that a prayer be submitted along with the application. The prayer should be "generic" in the sense that no personal names should be used. We will be using these prayers at some point in the future as part of a larger, on-going project for the St. Nicholas Neighbor in Need Foundation. The prayers may be published and the "authors" will remain anonymous. Please express your heartfelt prayer below.

How did you hear about us?

Recipient Application

Thank you for submitting an application to be considered as a foundation recipient!