SJ4H Financial Assistance Application

SJ4H Financial Assistance Application

A Program of Lost&Found
Application Overview

Lost&Found's Survivors Joining For Hope (SJ4H) postvention services department provides financial support for families that have suffered a loss by suicide. Applications should be filled out by the primary family member or loved one handling financial responsibilities. One application per family.
Guidelines for financial assistance:
- Financial support will be provided to approved applicants no more than one year following the loss of a family member or loved one by suicide
- All approved funds must be paid directly to a company or organization providing support to the impacted individual/family seeking support
- Applicants must reside in SD, MN, IA with preference given to SD residents
- Qualifying Expenses: funeral expenses, burial expenses, grief counseling, legal fees, or expenses deemed necessary by Lost&Found Advisory Committee
- Individuals and families applying for assistance must have experienced the loss of a family member or loved one by suicide.
- Financial support will be provided to approved applicants no more than one year following the loss of a family member or loved one by suicide.
- Either the applicant, funeral home, or local coroner must verify cause of death prior to the distribution of funds.
Lost&Found programming supports youth and young adults (ages 10-34) and their support networks. Preference will be given to applications to support these groups.

Assistance amounts are determined on a case-by-case basis by the SJ4H Advisory Committee for approval and assistance amounts (within service area/majority, beyond service area/unanimous). Maximum assistance is $2,500 per family unless circumstances dictate otherwise.

Lost&Found will consider all applications regardless of applicant's race, gender, age, religion, sexual orientation, and financial ability.
Applicant Information

Person Completing the Form
Name *

First Name Last Name
Relation to Deceased *
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Household Size *
Annual Household Income *

Less than $10,000 $10,000 to $19,999 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 to $79,999 $80,000 to $89,999 $90,000 or more
Race *

White / Caucasian Black or African American Hispanic or Latinx Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Other
Tribal Enrollment (if applicable)
Gender *
How did you hear about us? *
Loved One's Information
Name *

First Name Last Name
Age *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Gender *
Race *

White / Caucasian Black or African American Hispanic or Latinx Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Other
Tribal Enrollment (if applicable)
Name of College or University attended at time of death (if applicable)
Was your loved one a Veteran of the armed forces? *

Yes No
Assistance Request

Please note that assistance will only be provided for fees/services with an outstanding invoice as the payment is made directly to service providers. Payments are not made directly to applicants or their families.
Type of Assistance Needed *

Funeral Assistance Burial Fees Grief Counseling Legal Assistance Other Financial Needs
Amount Requested for Assistance *
Funeral Arrangements
Funeral Home *
Contact Person & Phone Number *
Cemetery *
Does the deceased have a plot? *

Yes No
Cremation or Burial? *
Date of Services *

Month Day Year
Date
Should be Empty:

SJ4H Financial Assistance Application

Application Overview

Applicant Information

Loved One's Information

Assistance Request

Funeral Arrangements