Apply - Marked by Memory Foundation

When life changes,

help shouldn’t be

far behind

Marked by Memory Foundation provideds financial assistance for accident-related needs, with approved payments made directly to vendors and service providers.

Start here. We’ll walk you through the application.

Marked by Memory Foundation provides financial assistance to families impacted by traffic accidents, including families navigating the loss or critical injury of a loved one.

WHO CAN SUBMIT AN APPLICATION?

Anyone with knowledge of a family in need may submit an application on their behalf.

Family Member

Immediate family or household member

First Responder

Police, Fire, EMT or Paramedic

Law Enforcement

Sheriff’s Office, Police Department or other law enforcement agency

Medical Professional

Doctor, Nurse, Hospital Staff or other care professional

Clergy / Community Support

Pastor, Chaplain, Counselor, Grief Counselor or other trusted community support person

Information submitted through this application is kept confidential and used for the purpose of reviewing the request for assistance.

HOW IT WORKS

Applications submitted on or before the 3rd Friday of each month

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Applications are reviewed during the last week of the month

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Applicants are notified by the last day of the month

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If assistance is approved, vendor payments are made during the first week of the following month

IMPORTANT TO KNOW

Assistance is for traffic accident-related needs.
Assistance may be considered for families navigating the loss or critical injury of a loved one.
Payments are made directly to approved vendors or service providers.
No cash payments are made directly to recipients.
Assistance is dependent upon available Foundation funds.
Submitting an application does not guarantee financial assistance.

Application Form

1. Applicant Information

About the person submitting this application — who may or may not be the person receiving assistance.

Full Name

Relationship to Recipient

Phone Number

Email Address

2. Recipient Information

Full Name of Recipient

Date of Accident

City

State

3. Please tell us what the family is facing right now.

We do not need the details of the accident. Please tell us about the circumstances creating the current need, what the family is facing, and the type of assistance that may help.

Current Circumstances

4. Type of Assistance Needed

Select all that apply.

If Other Critical Need — please describe:

5. Vendor Information

Because Foundation assistance is paid directly to vendors and service providers, please provide vendor information if it is currently available. These fields are optional at this stage.

Vendor / Service Provider Name

Vendor Phone Number

Amount Requested, if known

By submitting this application, you affirm that the information provided is true and accurate to the best of your knowledge.

You are not alone.

Thank you for reaching out. Our team will review the information provided and contact the applicant regarding the next steps.