Name: Hamot Health Foundation
Price range: $

Before You Apply

Review the United Charities Employee Hardship Grant Policy

This policy outlines the guidelines and procedures for receiving financial assistance.

United Charities Employee Emergency Assistance Policy PDF (89 KB)

For Assitance

Please call 814-877-2881 or email Sarah Prylinski from our Community Outreach Team if you would like help navigating additional community resources.

Fields marked with are required.

Please ensure you can check ALL of the following boxes prior to completing the application below for assistance

I am a full time or part time employee (per diem and student are excluded)

I have worked one (1) calendar year of service or more at UPMC Hamot

I have not been placed in disciplinary action at the written warning or higher level in the past one (1) rolling year

My emergency was caused by one of the following and fits into the eligible employee emergency examples provided by the guidelines reviewed (catastrophic event in the past 90 days, natural disaster in the last 90 days, life threatening /serious illness of employee that resulted in greater that 90 days of lost work, critical injury to employee due to accident that resulted in greater than 90 days of lost work, loss of home leading to active homelessness)

I have actively searched for assistance from other resources

If you have checked ALL of the boxes above, please continue with completion of the form below.
If you are unable to check each of the boxes above, your circumstances do not qualify for support from the United Charities Fund.

First Name

Last Name

Address

City

State

Zip Code

Rent or Own

Number of people living in househould

Phone

Email

Current UPMC Hamot Department

Job Title

Supervisor Name

Total number of years at UPMC Hamot

Describe the circumstances that caused the need for assistance (please attach any supporting documents):

Please explain your current needs:

Are you experiencing food insecurity?

Are you at risk for homelessness?

Please attach supporting documentation here:

Apply for United Charities Support

Before You Apply

Review the United Charities Employee Hardship Grant Policy

For Assitance

For Corporators

For Volunteers