APPLICATION

Submission of an application and compliance with the above does not in any way constitute an offer healthcare funds. The Global Altruism Foundation may (but may not) invite you attend an interview at their discretion. When selecting applicants for Healthcare Funds the following issues will be taken into account: impact on well-being. The Global Altruism Foundation's decisions regarding selection to the program are final.

Answer all questions honestly and to the best of your ability.
Do not leave any questions unanswered. If the questions do not apply, write N/A as a response.
 

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* 1. Picture of Yourself

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* 2. Address

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* 3. Is this cell phone number able to be reached via What's App?

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* 4. What is your preferred method of contact?

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* 5. Please explain what type of healthcare or healthcare supplies or equipment is needed.

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* 6. Who needs this healthcare treatment?

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* 7. Has there been any treatment?

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* 8. What type of treatment has been done?

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* 9. What type of medical professional has been saute out for treatment?

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* 10. Describe the effects of not receiving this healthcare help.  Such as, impairs vision, eating or ability to not obtain an education.

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* 11. Is there an immediate medical need?

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* 12. What type of immediate medical need improves the current situation?

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* 13. Who can help provide care for this person(s) health immediately?  Include medical professional and home healthcare or family members.

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* 14. What type of routine healthcare can improve the situation?

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* 15. ? Include medical professional and home healthcare or family members.

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* 16. Describe the future needs.

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* 17. What future planning can approve the outcome for this type of situation?

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* 18. Who can help provide care for this person's health in the future?  Include medical professional and home healthcare or family members.

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* 19. What would you like to tell us about your family background?

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* 20. What would need to be done to meet this person's current or future employment goals?

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* 21. List a few hobbies, interests, activities or sport you enjoy.

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* 22. Is there anything else about yourself that you wish to share with us?

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* 24. What language(s) do you feel you speak fluently?

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* 28. Do you have any additional feedback for the Global Altruism Foundation?

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* 29. Submission of Application

Date / Time

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