Immediate Needs Fund – Request Form

The Employee Giving Committee accepts requests on Mondays and Wednesdays. Once an employee submits a request, they will receive a response within 72 hours of the request being reviewed. Due to current work conditions, there may be a delay in the disbursement of funds.

Program guidelines

To assist patients/participants who do not have access to basic necessities that affect their health and well-being.
Those who do not qualify for this program:
  • AltaMed employees including: contractors, per diem, interns and/or AltaMed fellows
  • Family members of an AltaMed employee (including domestic partner, children, siblings, aunts, uncles, cousins, nieces, nephews, and/or grandparents)
  • We do not fund requests for rent. Please submit for other necessities to offset the cost of rent.
  • We do not fund requests for AltaMed co-pays. If requesting for co-pays, specify that co-payment is for health services that are not provided by AltaMed.

Examples of eligible needs are:

  • Food & related items
  • Specialist appointment co-pay *
  • Medication/Rx co-pay *
  • Transportation to specialist appointment
  • Home essentials
* We do not fund requests for AltaMed co-pays. If requesting for co-pays, specify that co-payment is for health services that are not provided by AltaMed.