Before applying, please review the United Charities Employee Hardship Grant Policy outlining the guidelines and procedures to receive financial assistance.

United Charities Employee Emergency Assistance Policy

Please reach out to Sarah Prylinski from our Community Outreach Team if you would like help navigating additional resources in the community.

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 Number

Current UPMC Hamot Department

Job Title

Supervisor Name

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?

Yes

Are you at risk for homelessness?

Yes

Please attach supporting documentation here:

Drag and drop files here or click to upload

UPMC Hamot Employee request for emergency assistance through the United Charities Fund

Employee Giving