Gifted Wishes
  • About Us
    • Board of Directors
    • Staff
  • Wish Stories
    • Santiago
    • Ella
    • Gary
    • HR
  • Wish Application
    • Gifted Wishes Granting Policy
  • Gala Event
    • Memorial Fund
  • Ways to Give
    • Donate Your Car
    • GW + Pixie Project
  • Contact
  • DONATE

Gifted Wishes Application

Please use our Online Funds Application and Liability & Authorization Form to submit your application.  Simply fill in the information as requested and complete your e-signature at the bottom.  As you move through the process there are (?)'s at many of the boxes which contain information to help you fill out the form if you need further information.



    Online Funds Application

    Please give us the name of the person making the request. This could be the patient, or a person requesting on behalf of the patient.
    Please share with us a description of the situation, the affect on the patient, their family situation and any relevant details of the wish.
    PLEASE NOTE:  
    ​Please remit receipts to Gifted Wishes at the conclusion of the Gifted Wish for our records as per the laws that govern a 501(c)(3). Thank you for your cooperation.

    Gifted Wishes
    6663 SW Beaverton Hillsdale Hwy. #63
    Portland, Or.  97225

    Liability release and authorization: Financial Agreement, Medical Information and Publicity

    Please share with us the full name of the Wish Recipient. This information is kept private and confidential, but is required for our 501(c)(3) book keeping.
    By way of letting us know your patient is in hospice care is considered 'medical information', we will not ask for additional information about their medical condition outside of the requirement that they be a hospice patient to qualify as a Wish Recipient. This is usually done in the form of a tweet, or a facebook post similar to but not exactly like one that says, "PNW Hospice Foundation just sent A.J. off to cast his last line on an all-day fishing trip... we hope he and his family have a wonderful time." Additionally, for Wish Recipients or their families who write us a Testimonial and send in photos, as requested, those are also posted or shared in various media formats.
Submit


If you would like to print and mail the signed Liability and Authorization form and your Funds Application, please download each form by clicking on the respective buttons below.

You can mail your forms to:
Gifted Wishes
6663 Beaverton Hillsdale Hwy #63
Portland, OR  97225
Liability Statement
FUNDS APPLICATION

Contact

Gifted Wishes
6663 Beaverton Hillsdale Hwy #63
Portland, OR  97225

503.297.5250
jean@giftedwishes.org
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
As a registered nonprofit corporation in Oregon, the PNW Hospice Foundation is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code.
  • About Us
    • Board of Directors
    • Staff
  • Wish Stories
    • Santiago
    • Ella
    • Gary
    • HR
  • Wish Application
    • Gifted Wishes Granting Policy
  • Gala Event
    • Memorial Fund
  • Ways to Give
    • Donate Your Car
    • GW + Pixie Project
  • Contact
  • DONATE