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Application for Assistance

Preferred Method of Contact
What type of assistance are you applying for:*
Are you comfortable providing family income information (proof of income documents may be requested)?

We Fund Care (Ryan Saturno Patient Amenities Fund) takes your privacy very seriously. We ask for your consent to collect, use, and disclose your personal information to review and assess your needs and determine your eligibility for assistance under our fund. We do not share your information with third parties without your consent, unless required by law or to administer our program. If you do not agree to our use and disclosure of the information above, we may not be able to provide you with the assistance that you are requesting.

By checking the box below, you are consenting to our collection, use and disclosure of your personal information as described above, and certifying to us that you have the approval of the person(s) whose personal information is contained in the application.

Thanks for submitting!

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