Fields marked with an * are required
Financial & Employment Impact of Child's Medical Situation
*Please select the best approximate total dollar amount for each of the following categories below in relation to your child’s hospitalization:
Mortgage Information - IMPORTANT
For verification purposes, please list the name(s) and social security #(s) of the person(s) who is/are listed on the mortgage:
*Please Note: Payments must be paid in full by the 10th of the month when verified or the application will be denied.
By typing my/our full name(s) into the text field below, I/We hereby authorize the mortgage company listed above to provide my/our loan status to Spare Key.
Note: If an application is approved but the housing payment exceeds the approved Spare Key housing grant amount, the applicant must be able to pay the difference between their mortgage payment amount and the approved Spare Key housing grant amount or the grant will be voided.
Spare Key Consent Form
Application Consent and Authorization:
By typing my name(s) into the below signature fields I authorize that I have read and understand the Spare Key Guidelines. I attest that all information on this application is true to the best of my knowledge. I authorize Spare Key and my medical care provider to discuss my family’s medical information pertinent to this case.
Sharing Your Story:
It is extremely important for future donors to hear directly from the Spare Key Families about the impact that the mortgage grant has made in their lives. Periodically, we look for families who are willing to share their story in order to help us raise awareness about the important service that Spare Key offers. Are you willing to share your family’s story in the future?
Spare Key Survey:
If approved, approximately 90 days after receiving the mortgage grant, you will be emailed an easy and brief online survey concerning the services and assistance that you received from Spare Key. The information received through this survey will be used to help secure additional funding as well as help us to better serve future families facing their child’s medical crisis. Families are eligible to receive mortgage assistance from Spare Key regardless of their willingness to complete the survey.
Medical Information Form
Dates of child’s hospitalizations:
Need actual social worker information (NOT general hospital information) or application will be denied.