Once we receive your information, we will review your request at our next Board of Trustees  meeting.  We will contact you shortly after the meeting. Thank you for taking the time to submit your information.  Please understand that is our desire to help every family that requests assistance, but unfortunately, the reality is, we just don’t have the funds to help every family.    If you prefer to mail in your application for assistance as opposed filling out our online application, please click here

APPLICANT INFO
Applicant Name *
Applicant Name
Person completing this form
Applicant Address *
Applicant Address
Applicant Phone *
Applicant Phone
BENEFICIARY CONTACT INFO
Beneficiary Name *
Beneficiary Name
Beneficiary Address
Beneficiary Address
Phone 1
Phone 1
DETAILS
Please provide a detailed explanation of the reason the family needs the support of Steps Together. Please include patient name, diagnosis, date of birth and date of diagnosis.
Lost income, unreimbursed medical expenses, extensive hospital stays, etc.
How can Steps Together help?