United Charities Employee Emergency Assistance Program

Application Process

Before You Apply:
1. Review the United Charities Employee Hardship Grant Policy (PDF)
2. Verify you can check ALL of the following boxes:
- You are a full-time or part-time employee (not per diem or student)
- You have worked one (1) calendar year or more at UPMC Hamot
- You have NOT been placed in disciplinary action at written warning or higher level in the past one (1) rolling year
- Your emergency was caused by one of the eligible circumstances and fits guidelines
- You have actively searched for assistance from other resources

If you cannot check all boxes, you do not qualify.

Application Form Sections:

1. Personal Information:
- First name
- Last name
- Address (city, state, zip)
- Phone number
- Email

2. Household Information:
- Rent or own status
- Number of people living in household

3. Employment Information:
- Current UPMC Hamot Department
- Job title
- Supervisor name
- Total number of years at UPMC Hamot

4. Emergency Details:
- Describe the circumstances that caused need for assistance (with supporting documents)
- Explain your current needs

5. Resource Seeking:
- Check any resources from which you have applied for assistance:
- UPMC Hardship Grant Program
- Homeowners or Renters Insurance
- Auto Insurance
- Medical Insurance
- Social Services Organizations
- FEMA
- Religious Community
- Family Members Loan Program
- Other

6. Vulnerability Assessment:
- Are you experiencing food insecurity? (Yes/No)
- Are you at risk for homelessness? (Yes/No)

7. Documentation:
- Attach supporting documentation (file upload)

Submission:

Submit completed form online

Contact for Assistance:

For help navigating application or additional community resources: Sarah Prylinski, 814-877-2881