Share Your Story - United Healthcare Children's Foundation

Are You a UHCCF Grant Recipient? Share Your Story

*asterisk indicates required

Parent Name
- Parent Name*
  First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Please List Others in Household

Spouse/partner, siblings, grandparents, etc.
Grant Recipient
- Grant Recipient*
  First Last
Recipient's Date of Birth*
Month
Day
Year
Recipient's Age at Time of Grant*

Separate ages with a comma if multiple grants have been awarded.
Grant ID Number*

To obtain grant ID #, go to applicant log-in
Interested?
- Would you be interested in having your family's story featured in a short video by UHCCF?*
In your own words, why did you apply for a grant?*
What specific medical needs did the UHCCF grant help support?*
How has your child's life changed since receiving the grant(s)?*
What are your child's passions or favorite pastimes?*
Share any accomplishments you or your child are particularly proud of.*
What dreams does your child look forward to achieving in the years ahead?*
Share Photos
- Share photos of your child and images of their art to help tell their story. If they benefit from a brief description or caption, include some basic info below.
  Drop files here or
  
  Accepted file types: jpg, png, Max. file size: 10 MB.
Confirm Signed Release*
Confirm signed release
By signing the above line you agree the photo, child's first name, last initial, city, state and age can be shared on UHCCF's social media sites/marketing materials. You agree that all submitted information above becomes the exclusive property of UHCCF. You agree to transfer all rights in and to the submitted image and information. You agree not to submit any material which is knowingly false and/or defamatory, inaccurate, or otherwise violates any law. You agree not to submit any copyrighted or trademarked material unless the copyright is owned by you.

Questions regarding the rule and regulations can be directed to customerservice@uhccf.org
Phone
This field is for validation purposes and should be left unchanged.

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Are You a UHCCF Grant Recipient? Share Your Story

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