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THE LAST GOODBYE
ASSISTANCE APPLICATION
Last Name
First Name
Address
Phone Number
Email
Proof of Identity for the Applicant (e.g., driver’s license, ID card)
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Full Name of Deceased Recipient
Date of Passing
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required
Proof of Recipient’s Passing (e.g., death certificate)
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Brief Description of Recipient’s Association with United Colors of Pink
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I, the undersigned, declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that the funds provided under the Last Goodbye Assistance Program are intended to honor the legacy of Pink Helping Hand recipients and must be used respectfully.
Applicant's Signature
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Date
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required
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