If you know of a local family, experiencing
the first 14 months of acute illness, injury, natural disaster or grief
please fill out the form below and read about the ways that we can
help. We will be in contact you after receipt of the form.
If you have questions before completing the form, please call
Melissa Pappolla at 908.766.4400 or email at info@heartworksgroup.org.

    Date:

    Person who cares about them (Your name & Contact Info):

    Family Information (You are referring):

    Description of the Situation:

    Names of Family Members:

    Specific Ideas as to what would help:

    Here is what Heartworks can offer:

    A general check written out directly to the family.

    This can cover bills or anything that would create a ‘pocket of joy or relief’ for
    the family. By ‘pocket of joy or relief’ we mean it will hopefully give them the ability to do something or pay for something that feels overwhelming due to this situation.

    Some ideas are:

    • summer camp
    • a family trip
    • back to school shopping
    • holiday celebrations / birthday parties
    • gym membership / personal training
    • lawn care / home projects
    • house cleaning
    • medical bill assistance
    • groceries

    These are just suggestions and ideas, we want to help, in any way, that is personally best for this family.

    Thank you for sharing this family with us. We will review the referral with our Advisory Council and get back to you as soon as possible.
    If you have any questions, please call Melissa Pappolla at 908.766.4400 or
    email her at info@heartworksgroup.org.