Medical Hardship Application for Assistance

Please print and mail completed form to:

Tracey Stapleton, Hospitality Heroes Fund

1616 Camfield Lane

Mt. Pleasant, SC  29466

Full Name _________________________________________________________

Address __________________________________________________________

City, State, Zip Code ________________________________________________

Home Phone # ________________________  Cell Phone # _________________

Employer _________________________________________________________

Job Position _______________________________________________________

How long at present job? _____________________________________________

Previous employer and position if not longer than one year _______________________

Please describe your medical hardship and how it affects your ability to make ends meet (or explain your current most critical need).

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Please tell us how you found out about the Hospitality Heroes Fund.

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Please call 270-4700 for any further questions. 

Applications will be reviewed by the Hospitality Heroes Fund Board of Directors on a monthly basis.