TRANSPORTATION – Auto
Apply online (must complete all)
- Patient financial profile (dated within 6 months of request)
- Transportation assistance application form
- Current monthly payment coupon with address for remittance - upload file
- At least 3 estimates for repair - upload file
- Car Payment / Repair Assistance Consent Form
- A letter detailing other agencies contacted and their decisions; how the patient got into the financial crisis; and a plan to avoid the need for future car payment / repair assistance – upload file
For paper applications:
Upload completed PDFs
Don't forget to also upload:
- Current monthly payment coupon with address for remittance - upload file
- At least 3 estimates for repair - upload file
- A letter detailing other agencies contacted and their decisions; how the patient got into the financial crisis; and a plan to avoid the need for future car payment / repair assistance – upload file