Pediatric Technology for Hope Assistance Application Guidelines

 

When submitting your application, please follow the detailed instructions below. This is the only way to ensure that your application is reviewed and submitted for approval.

 

Please note that when utilizing one or more of the pediatric programs, there is a dollar cap of $599.99. Please keep this in mind when applying for multiple programs. This is per IRS regulations and our program policy guidelines.

 

Before completing the application, please review the following policy guidelines:

 

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If you have access to DocuSign, it may be used to obtain the required signatures. However, the instructions below MUST be followed, no exceptions!

 

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Below are the steps to submit a Pediatric Technology for Hope Application:

 

Download and complete the main application:

 

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Download and complete the gift request form, if needed:

 

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Once all required information is obtained, please submit the application and supporting documentation, in PDF format, to info@hpcfoundation.org. Please note that we cannot accept pictures of the application and/or supporting documentation:

 

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If you do not have access to your company letterhead, you can use the HPCF approved verification form, which can be found by clicking the button below. This is NOT the preferred method, but is acceptable if there is NO other option. An email verifying a patient’s hospice status WILL NOT BE ACCEPTED!

 

 

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We welcome your feedback. Please click on the button below:

 

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If you require additional assistance, please reach out to us at 855-219-1648 or by emailing us at info@hpcfoundation.org.