The Spirit of Giving program supports LG Health employees and their families who are facing a serious or emergent need* during the holiday season.
 
To be considered for acceptance into the Spirit of Giving program, you must complete and submit this form by October 23, 2020. Upon completion, your application will be reviewed by the Spirit of Giving Committee and you will receive notification and additional information if you are accepted into the program. (Not all employees are able to be accepted into the program. If your application is declined, you will be notified and provided a reason.)
 
All applicants and their information will remain anonymous.
 
*LG Health defines a serious or emergent need as a situation where adverse financial consequences occurred as a result of a spouse/significant other being furloughed or laid off, having reduced work hours, being quarantined, being unable to work due to lack of child care, unexpected medical expenses, or illness, injury or accident, and death.

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* Employee Information
*Note: Please review the entire form before starting to ensure you have all of the necessary information. There is no 'save for later' option. If you exit before submitting the form, all information that was entered will be lost.

Employee First Name

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* Employee Last Name

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* Employee Number
*This number is located on the back of your badge below your name (first 6 digits).

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* Work Location

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* Department Name

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* Primary Email Address
*Email will be the primary method of all Spirit of Giving communication, including acceptance status, instructions, questions, guidelines, directions, etc. Employees should check and respond to email regularly. The provided email address can be either your personal or work email account.

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* By checking this box, you acknowledge that you understand that email will be used as the primary communication and you are responsible to regularly check and respond as needed.

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* Primary Phone Number
*Phone number will be used in situations where immediate contact is required. Please include the area code (ex. XXX-XXX-XXXX).

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* Please describe the serious or emergent need* you are facing this holiday season.
*LG Health defines a serious or emergent need as a situation where adverse financial consequences occurred as a result of a spouse/significant other being furloughed or laid off, having reduced work hours, being quarantined, being unable to work due to lack of child care, unexpected medical expenses, or illness, injury or accident, and death.
 

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* Have you participated in the Spirit of Giving program in the past?

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*
Family Information


Please list the first name, age, gender and relationship to you, of your immediate family members*. Please also include your first name, age and gender.  

EXAMPLE: JOE, M, 18, SON

*LG Health defines immediate family, as those individuals living within your household that are financially dependent on you. Typically these individuals can be claimed on your tax return (i.e., spouse, children (biological, step, or adopted).

All participants in this program will remain anonymous. Only age and gender information will be shared.

*If including a family member not covered under the LG Health definition of immediate family, please include an explanation of how they are financially dependent on you. This information will be used to determine their eligibility for acceptance into the program.

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* If needed, please add any additional immediate family members in the space below.

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* Transportation

The Spirit of Giving event will be held on Wednesday, December 9, 2020 at the Clipper Magazine Stadium.

Please note, if accepted into the program, you are responsible to pick up and transport your gifts. A vehicle with available storage space will be needed. If pick up cannot occur on this date, you are responsible for making other arrangements.

Additional information, including gift pick up instructions and directions will be provided to you by November 30, 2020.


By checking the box below, you acknowledge your understanding of the transportation requirement for gift pickup.



To complete and submit this form, please click the Submit button below. If accepted into the Spirit of Giving 
program, a Family Coordinator will reach out to you with your specific family number, as well as additional
information no later than October 28. This Family Coordinator will be your resource throughout the process.

If you have any questions prior to hearing from your Family Coordinator, 

please email LG-SpiritOfGiving@pennmedicine.upenn.edu.

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