Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to obtain the application form and open it in the relevant editor.
2. Begin by entering the date of application in the designated field to indicate when you are submitting the form.
3. Provide your full name in the 'Name of applicant' field as it appears on official documents.
4. Enter your Social Security Number in the appropriate section, ensuring that this sensitive information is accurately reflected.
5. Fill in your current residential address, including street, city, state, and zip code, to ensure correct identification.
6. Enter your telephone numbers in the designated fields, including home and work, followed by your email address for any correspondence.
7. In the 'Place of Employment' section, write the name and address of your current employer.
8. Describe the medical and/or dental expenses for which you are requesting assistance. Ensure to list items that are not covered by your insurance or third-party provisions.
9. Attach a copy of all relevant invoices, insurance claims, or any documentation that supports your request for assistance.
10. Indicate the total amount of funding you are requesting. Note that this must be at least $200.00.
11. Provide a brief statement detailing your reasons for needing assistance with these expenses, ensuring clarity and completeness.
12. Finally, sign the application to confirm the information is accurate and complete before submission.
13. After completing the application, you can save changes, download the form for your records, print it if necessary, or share it as needed.

Complete your CT Nurses Association Elizabeth Kirk Fund Application online today.