The Foundation can provide support to your family by assisting with the costs of temporary housing near the pediatric facility where your child is being treated.

In Oregon, the Foundation makes Elijah’s Heart House available as a family retreat for a peaceful respite.

How We Support Families

Elijah’s Heart House can help families in one of these three ways:

Assist with costs across the United States.
Reimburse temporary housing in Oregon
Social Workers or Medical Professionals can apply for a grant.
EHH will respond within 5 business days if your application is pre-approved.

*Please have your documentation and information ready before you begin your application.

GRANT APPLICATION

Patient’s Social Worker or Parent/Guardian must fill out the form completely and submit documentation for your application to be considered for pre-approval.

The foundation gifts grants, after we have reviewed and spoken with the family prior to or during the hospital stay. Each application will be reviewed and a specific amount granted according to the needs of the family.

Application for Housing

APPLICANT INFORMATION

Applicant's Name *

First Name

Last Name

Applicant's Phone *

(###)

###

####

Applicant's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is your relationship to the patient?

Parent/Family Member

Social Worker

Other

How can we support you? *

Costs across the United States

Temporary Housing in Oregon

EHH Retreat Home

Before you can get a grant from EHH you must have already applied for housing at Ronald Mcdonald House. Have you already applied for the requested dates? *

YES

PATIENT INFORMATION

Patient Name *

First Name

Last Name

Patients Age *

Guardian Name *

First Name

Last Name

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email *

Phone *

(###)

###

####

Does anyone in the patient's immediate family have any current investigations involving a spouse, child, alcohol, or drug abuse? *

Yes

If yes, please briefly explain:

REASON FOR FUND REQUEST

Type of medical procedure *

Please share a brief description of the medical procedures you are facing

Date of Procedure *

YYYY

Procedure Facility Name *

Procedure Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Estimated timeframe for recovery *

Location of recovery for patient/family *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PHYSICIAN INFORMATION

Physician's Name *

First Name

Last Name

Hospital Name *

Social Worker's Name *

Social Worker Contact Information *

Include Email and/or Phone

Additional Information

Include any additional information you feel would be relevant or you would like us to consider.

Photo Release

We would be honored if you would take pictures of your family during your stay and either email them or text them to us. Our Elijah Heart House donors love meeting the families who stay at the house. We would share the photos on social media and through our newsletter to update our donors.

Yes

Have you previously applied to Elijah's Heart House? *

Yes

How were you referred to Elijah's Heart House?

Thank you for taking the time to give us information about your request.

NEXT STEP, PLEASE EMAIL YOUR DOCUMENTATION TO:

info@elijahshearthouse.org

DOCUMENTATION REQUIRED:

Airbnb, VRBO, hotel receipts
Physician Statement/Documentation

We will review your application and contact you as soon as possible.

Sincerely,

The Elijah J. Auxier Foundation

CONNECT WITH US

PO Box 144, Aurora, OR 97002
971-412-8068 | info@elijahshearthouse.org

ELIJAH J. AUXIER FOUNDATION

501(c)(3) Community Foundation

Join us to receive updates and information as we assist pediatric families in beginning their complex journey.

Email Address

We will respect your privacy.

Thank you for partnering with us to bring compassion, support, and provision to families experiencing the unimaginable.

With love,

The Elijah J. Auxier Foundation Team