Share Your Story

Submit Your Own Story

Personal Information
Parent Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Please list others in household (spouse, siblings)

Include ages of any siblings
Grant Recipient
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Age at time of grant

List ages if multiple grants received.
Grant ID
Would you be interested in having your family's story featured in a short video by UHCCF?
A Few Words:
Note: We will never share last names, address or contact information with the public without contacting you first for consent. We use only first name, last initial, city and state within grant recipient profiles. Please fill out only the information you feel comfortable sharing. Thank you!
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?
Photos & Art
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.
See how your child's photo will be used in our newsletter.
File
Photo Description or Caption:
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

Submit Your Own Story

Personal Information

A Few Words:

Photos & Art