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  • Adventist Midwest Health Financial Assistance Application Form

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Lephone # (optional) *Proof of income (1040 tax return) is required for debts of $20,000 or higher. Proof of income may be requested for debts less than $20,000. Please read before signing. I CERTIFY the information I have provided is true and accurate to the best of knowledge. I will make application for ANY and ALL ASSISTANCE which may be available through federal, state, local government and private sources to help pay this hospital bill and will take all action necessary to obtain assistanc.

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The body of the letter should clearly state your current financial situation; what caused the hardship; and what you would like the school, camp, or mortgage company to do about it. If possible, you should include financial statements or other paperwork that proves your claim of financial hardship.

Use the following steps when writing a letter of request: Include contact details and the date. ... Open with a professional greeting. ... State your purpose for writing. ... Summarise your reason for writing. ... Explain your request in more detail. ... Conclude with thanks and a call to action. ... Close your letter. ... Note any enclosures.

The body of the letter should clearly state your current financial situation; what caused the hardship; and what you would like the school, camp, or mortgage company to do about it. If possible, you should include financial statements or other paperwork that proves your claim of financial hardship.

Be direct about what the letter is for (financial aid) Briefly talk about why the school is a great fit for you and why you need the money in an straightforward and respectful way. Provide concise details regarding your specific financial situation, even if you gave these details in your original application.

Dear Sir, I want to request your kind support for my medical treatment (mention the medical problem or disease). During my last visit to the doctor/hospital (hospital name), they provided me with a minimum treatment estimate (mention the amount).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232