Refer a Family

Refer A Family

City/State that the family lives in: *

ELIGIBILITY REQUIREMENTS

I am referring: *

My own family

A friend or family member of mine

A family I work with as a medical or care provider

Other

Parent/Guardian Name:

APPLY FOR MEMORIAL GRANT

REFER A FAMILY

Information regarding the family I am referring: *

Your email address: *

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Child's Date of Birth: *

Child's Name: *

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We ask that you meet the following eligibility requirements, in order to receive assistance:

1) The recipient family must be full-time Oregon residents.

If you are applying for a memorial grant to pay for funeral, burial or headstone expenses, those funds can only be paid directly to a funeral home or cemetery, which must be located in Oregon.

2) The recipient of any assistance through the Macey Elizabeth Foundation must be the parent or legal guardian of a child (age 18 or under) who has passed away, or is receiving end-of-life care for a terminal condition, in a home or clinical setting with a hospice team. The child must live in the home with the parent or guardian. We do make exceptions on the age limit for cases where the child is over 18 but had a serious medical condition, disability or chronic illness that requires them to live at home with parents/guardians.

3) The services & assistance provided must directly benefit the intended family, and not be used for any other person or purpose, outside of this family.

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Your phone number: *

Name of person making the referral: *