Hope for the Change is extremely excited to begin another year of fundraising opportunities. Last year turned out to be an amazing success and we are ready to help and provide the resources necessary to improve the quality of life for someone out there seeking financial assistance. Whether you or someone you know is looking into a medical procedure, special medical equipment, or anything else related to improving one’s overall health that is not covered by health insurance, Hope for the Change is ready to hear your story and accept new applicants.

The form below is the only way Hope for the Change will accept new applicants. The beneficiary will be chosen by a committee that will thoroughly look through all submitted entries, validate whether it is legitimate, and research the type of assistance needed. In order to be approved as an applicant, you or someone you know must meet the following guidelines:

1. Live in Cedar City or surrounding areas (New Harmony, Enoch)
2. Have proof of the medical procedure including cost, documentation, preapproval for treatment, and anything else that will show evidence that it is the real deal.
3. Family must be willing to help and provide assistance throughout the entire fundraising process and will be required to sign a waiver showing Hope for the Change your utmost commitment.

Please fill out the form below and provide all the details necessary as to why you or someone you know would be the best candidate for financial assistance.

Hope for the Change takes privacy very seriously and will not use your information beyond the intent and purpose of this form.

New Applicant Form

* All fields are required

First Name: *

Last Name: *

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