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Financial Assistance Application YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE. Completing this application will help Shirley Ryan Ability Lab (SRA lab) determine if you can receive free or discounted
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01
Go to statements.franciscanalliance.org/images/charity/financialassistanceapplication
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Download the financial assistance application form from the website
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Fill out all the required information on the form
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Make sure to provide accurate and detailed information to support your application
05
Attach any necessary supporting documents, such as income statements or medical bills
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Review the completed application form and supporting documents for any mistakes or missing information
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Submit the application form and supporting documents through the designated submission method specified on the website
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Wait for a response from the Franciscan Alliance regarding your financial assistance application

Who needs statementsfranciscanallianceorgimagescharityfinancial assistance application?

01
Individuals who require financial assistance for medical expenses or healthcare services at Franciscan Alliance
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The statementsfranciscanallianceorgimagescharityfinancial assistance application is a document used to apply for financial assistance from the charity.
Individuals or families seeking financial assistance from the charity are required to file the statementsfranciscanallianceorgimagescharityfinancial assistance application.
To fill out the statementsfranciscanallianceorgimagescharityfinancial assistance application, applicants must provide detailed information about their financial situation and the reasons for seeking assistance.
The purpose of the statementsfranciscanallianceorgimagescharityfinancial assistance application is to assess the financial need of individuals or families applying for assistance from the charity.
Information such as income, expenses, assets, liabilities, and reasons for seeking assistance must be reported on the statementsfranciscanallianceorgimagescharityfinancial assistance application.
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