Building on Love Screening Questionnaire

Welcome to our Building on Love potential grantee screening questionnaire. To complete the quick questionnaire, just click on the link below and complete the contact form and respond to the questions.  We will be in touch within 24 hours of receipt with an update.

An overview of our giving parameters:

  • The patient named in the application must be a member of a household with at least one parent/guardian supporting at least one child under the age of 18.
  • Our goal is to support financially stable working families as soon as possible so that their medical crisis does not result in an immediate fiscal crisis. 
  • Our financial support is intended to provide temporary financial bridge during a tough time.
  • As a small charity, we need to limit our funding scope.  We do not have the resources to support individuals fighting chronic/long-term health issues.
  • We pay bills directly to vendors on behalf of our families.  We do not provide any direct financial support to our families.