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Colleague Emergency Assistance Fund

Application for HSHS Colleagues

Hands on top of hands Hands on top of hands

The Colleague Emergency Assistance Fund is funded by colleagues to support colleagues in severe financial hardship. All funds distributed have been donated.

Please fill out and submit the form below for assistance.

Six digit number on back of colleague ID badge
Up to $500
Please note: Payments can take up to 7-10 business days to be processed and received once application is approved.
Please describe the event that is causing your financial need. Please be as detailed as possible, including expenses directly related to the event and other avenues of support you have explored.
Please provide vendor name, address and telephone.
Please attach copies of bill(s) or invoice(s) needing payment. Your payment will be expedited if you provide an IRS Form W-9 from the vendor(s). Get form here: https://www.irs.gov/pub/irs-pdf/fw9.pdf
Do you have prior applications for assistance since 1/1/2021?
I have read and understand the Colleague Emergency Fund Eligibility Guidelines
By checking this box, you attest that the information you have provided is true and correct.