Get Nexion Health Emergency Relief Application 2022-2025

Filling out the Nexion Health Emergency Relief Application is an important step for those in need of assistance due to unexpected life circumstances or natural disasters. This guide will walk you through the process to ensure you complete the application accurately and efficiently, enabling you to receive the support you deserve.

Follow the steps to successfully complete your application online.

1. Click the ‘Get Form’ button to obtain the application form and open it in the editor.
2. Fill in the date at the top of the form. This is important for documentation purposes.
3. Provide your daytime phone number in the designated space to ensure the Foundation can contact you if needed.
4. Enter your name as the applicant in the appropriate field. Ensure to include your full legal name.
5. Indicate your title within the organization to establish your role.
6. Input the name of the facility where you work.
7. Provide your email address for correspondence.
8. Indicate if you are a full-time employee by checking 'yes' or 'no'.
9. Fill in your date of hire to confirm your eligibility.
10. Complete your home address accurately to ensure proper communication.
11. Indicate whether you have discussed your application with your administrator by selecting 'yes' or 'no'.
12. Specify the amount of financial assistance you are requesting.
13. Provide a brief description of the reason for the requested check.
14. Describe the nature of the emergency in the section provided, offering as much detail as possible.
15. If applicable, fill out the contact information for the person submitting the application on behalf of a co-worker, including their name, relationship to the applicant, daytime and evening phone numbers, and email address.
16. Ensure that you have included any supporting documentation such as invoices or receipts as required.
17. Review the completed application for accuracy and completeness. Save changes, download a copy, and/or print the form if needed. Finally, electronically submit the application as instructed.

Start filling out your Nexion Health Emergency Relief Application online today!