Adult Gift & Relief Fund
(previously Needs & Assistance Fund)

Before completing one of the following gift request forms please read the guidelines below by clicking the purple button.

The Foundation provides one-time emergency relief to individuals receiving hospice care in South Carolina. This program provides help to those who are unable to pay for critical unfunded expenses. This can include but is not limited to assisting with utility bills, mortgage payments, and wheelchair ramps. "Small gifts" in the amount of $100 or less are also available and can include gas/grocery cards, nutritional supplements, and other needed items.

** Applications must be submitted by a member of the patient's hospice or palliative care team. 
** NOTE: We do not provide reimbursement for payments already made or items purchased.
** The bill or invoice must be in the adult patient’s name for which the relief fund is being awarded. 


 

If you have access to Docusign, it may be used to obtain the required signatures. However, the instructions below MUST be followed! You can find the instructions by clicking the purple box titled "Docusign Instructions."
If you do not have access to your company letterhead you can use the document below by clicking the purple button.
** This is not the preferred method! But, can work if there is no other option.

Adult Relief Fund Request
(Up to $500)

Please follow the steps below to submit an Adult Relief Fund Request.

1. Please download and complete the request form below by clicking the purple button. 

2. Some companies may be required to complete a W9 form in order to receive payment for services 

3. Please have your social worker provide a typed letter on company letterhead verifying the patient is currently on hospice services or was at the time of their death. 

** If you do not have access to your company letterhead you can use our alternative letterhead, which can be found at the top of this page by clicking the purple button titled "Letterhead Alternative Option."

4. Please provide the patient's unpaid bill or invoice of $500 or less when submitting.

5. Once all the required information is obtained. Please submit the form by emailing it in pdf form to info@hpcfoundation.org

6. Please let us know your thoughts!

Small Gift Request 
(Up to $100)

Please follow the steps below to submit a Small Gift Request

1. Please download and complete the form below by clicking the purple button. 

2. Once all the required information is obtained. Please submit the form by emailing it in pdf form to info@hpcfoundation.org

3. Please let us know your thoughts!