Angels Around Us Overview — The Pearce Family Foundation

Thank you for your interest in the Pearce Family Foundation’s grant, Angels Around Us

Angels Around Us of Arizona is the Pearce Family Foundation's main initiative and it exists to financially help families who have a child suffering from a life-threatening or chronic illness. Angels Around Us has been created to make the community aware that, "The Diagnosis is Just the Beginning". The Pearce Family Foundation has a committee that will select families who meet the requirements of being a part of Angels Around Us. The funds will be raised through events within our community as well as donations. Angels Around Us hopes to relieve stress the family may be facing so our main focus is on their child’s journey to get well.

You must be living in Arizona and your child must be between the ages of 1 day old-17 years old to be eligible.

Financial Assistance May Include:

Rent/Mortgage Payments
Transportation Needs
Auto Repair/Car Payments
Anything that Creates a Stable and Healthy Living Environment

*Certain needs will vary; the Pearce Family Foundation reserves the right to decide what falls in these guidelines.

All Applications details are kept confidential. Angels Around Us cannot meet every request and cannot provide large gifts for medical procedures. However, some assistance is generally available for things such as transportation, housing, electric and water bills, and other MAJOR needs.

WE DO NOT PROVIDE COSTS FOR THE FOLLOWING:

Cox/Direct TV Cable Bills
Security Deposits
Medical Bills/Procedures
Insurance
Groceries

Families may be prioritized by need but no family will be ineligible because of their income level. Angels Around Us reserves the right and the applicant hereby grants permission for PFF to share all of the information provided by the applicant, including but not limited to, medical information, to third parties on a as needed basis. You may apply once every 12 months for the Angels Around Us grant. After applying, we will reach out asking for a letter of recommendation from your doctor or social worker, any photos that you’re willing to share with our donors and supporters and a copy of your most needed upcoming bill. The foundation requests that the bill is submitted at least TWO weeks prior to the day it is due.

A committee of local individuals will be reviewing your grant and will be in touch with you regarding your needs. If you have questions please contact us at info@pffarizona.com.

-The Pearce Family Foundation

*All participants must fill out the online application completely before being considered by our team

Angels Around Us Application

Child's Information

Child's Name

First Name

Last Name

Diagnosis

Gender

Age

Birthday

YYYY

Blurb of your child's diagnosis and treatment journey so far

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main hospital child is being treated at

How often are you at the hospital?

Names and ages of siblings

Parent/Guardian Information

Primary Guardian's Name

First Name

Last Name

Relation of Primary Guardian to Child

Primary Guardian Phone Number

(###)

###

####

Primary Guardian Email Address

Household Monthly Income

Secondary Contact Person

First Name

Last Name

Secondary Contact Relation to Child

Secondary Contact's Phone Number

(###)

###

####

Secondary Contact Email Address

Community Support Information

Has the patient's family received assistance from the Pearce Family Foundation before?

Does patient family receive assistance from other agencies? If so list the agency:

Who referred you to PFF/Angels Around Us Grants?

Reference Contact Information

Additional Items/Needs (please list - Ex: gas cards, furniture, clothes)

Parent/Guardian Certification Application for Financial Assistance

I certify that the information given in this application is true and correct as of the date set forth opposite my signature and that any intentional misrepresentation of the information contained in the application will result in the loss of current and future assistance form Angels Around Us and may result in civil liability. The applicant releases Angels Around Us from any and all liability which may arise from the sharing of this information to third-parties. The Pearce Family Foundation reserves the right to run a background check on every applicant.

Parent's or Guardian's (Signature):

Date:

YYYY

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.