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Funeral Assistance Application

Our hearts are with your family during this unimaginable time. We understand that no amount of financial assistance can ease the pain of losing a child. The purpose of this application is simply to help relieve some of the financial burden so your family can focus on honoring your child's life. Please know that you are not alone.  

Child Information
Parent/Guardian Information
Home Address
Funeral Home Information
Assistance Requested
Please indicate what assistance you are requesting.
Financial Information
Have any other organizations or individuals committed financial assistance?
Yes
No
Family Statement
Supporting Documentation

Please attach copies of the following, if available:

  • Funeral home estimate or invoice

  • Death certificate (if available)

  • Physician or hospital verification of diagnosis (if requested)

  • Any additional documentation supporting your request

Payment Information

To ensure funds are used for their intended purpose, funeral assistance is generally paid directly to the funeral home or service provider.

Previous Assistance
Has your family previously received assistance from the Rylan Strong Network?
Yes
No
Emergency Contact (Optional)

I certify that the information provided in this application is true and accurate to the best of my knowledge.

I understand that submitting an application does not guarantee financial assistance.

I understand that assistance is dependent upon available funding and approval by the Rylan Strong Network Board of Directors.

I authorize the Rylan Strong Network to verify information provided in this application, including contacting the funeral home or medical providers when necessary.

I authorize the Rylan Strong Network to use images in social media, marketing, etc. 

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