HOPE Fund Application

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HOPE Fund Guidelines 

HOPEFund Workaround pic

Note: All applications are kept confidential.

PURPOSE:

The HOPE (Helping Overcome Personal Emergency) Fund is an employee relief program for Sentara. This program is funded by employees and managed by an outside human services agency (The Planning Council) to assist coworkers who experience catastrophic financial loss or hardship through no fault of their own such as fire, accident, death in the family, serious personal family illness, flooding, hurricane, or tornado.

Qualifying Event Examples

  • Current Personal Illness or Injury or Current Serious Personal Family Illness or Injury
    • Official Document Required: Form completed by physician and three most recent paystubs illustrating loss of income during the time of personal or family illness/injury.
  • Death in the Family (Family member who provides substantial income toward monthly household expenses)
    • Official Document Required: Copy of Death Certificate/Statement from Funeral/Obituary, proof of deceased’s address
  • Recent Fire, Flood, Hurricane, Tornado
    • Official Document Required: Red Cross or The Salvation Army Document. Police or Fire Department Report, FEMA document, or a Photo
  • Personal Tragedy- for example, non-receipt of child support, domestic violence, homelessness (reoccurrence of these events may not qualify for future funding)
    • Official Document Required: Court document/child support enforcement summary of account/police report.

Non-Qualifying Event Examples

  • Reduction of work hours not caused by a crisis or catastrophic event
  • Loss of overtime hours or loss of a second job
  • A family member’s loss of hours or employment
  • Care of an extended family member or friend, bills/expenses
  • Judgments, garnishments, and liens
  • Speeding ticket, fines
  • Funeral arrangements, plane tickets
  • Having to pay other household bills, such as utilities, cell phone, taxes

Expenses eligible for HOPE fund assistance:

  • Clothing
  • Food
  • Utilities (power, water, natural gas/propane, wastewater treatment, home/cell phone)
  • Furniture replacement
  • Rent/rental deposit
  • Temporary lodging (with confirmed move in or return date to permanent residence)
  • Structural repair to home as a result of current disaster
  • Cell phone bill

Expenses NOT eligible for HOPE fund assistance:

  • Credit card payments
  • Medical bills
  • Taxes
  • Anything listed in the non-qualifying events examples (See above)

ELIGIBILITY:
  • Open to all Sentara employees. Sentara Rockingham Memorial Hospital should direct assistance requests to the RMH Foundation by calling 540-689-8545.
  • Employees must be in good standing without any critical violation of the Code of Conduct at the time of application.
  • In the event of fire or natural disaster (i.e., flood, hurricane, or tornado), employees must first apply for aid from relief organizations such as American Red Cross (3-day hotel, food, and clothing vouchers), Salvation Army (furniture from local thrift store), FEMA, or similar programs. Please list organizations and provide proof of your applications.

Additional Guidelines:

The first step is to apply online at https://sentara.tfaforms.net/f/GETHOPE
  • The HOPE fund assistance is only for those who have experienced a crisis or catastrophic event due to no fault of their own and cannot assist with general financial shortages. However, you can call 2-1-1 from any phone for additional local resources.
  • Any applicant will not be eligible to receive more than the maximum allowable award per calendar year.
  • The independent HOPE Fund Review Panel at The Planning Council has final decision of the amount of funding per event.
  • Funds are only distributed to the extent that there are adequate employee donations to the HOPE fund balance.
  • Documentation of expenses must be provided.
  • Assistance requests may require either or both of the following:
  • A certificate of completion of a financial budgeting course from a list of organizations to be provided.
  • EAP counseling meeting certification

Communication of Awards:

  • Employees will be notified by e-mail of the assistance level approved.
  • The application process takes up to 3 business days AFTER submitting all documents to The Planning Council. For this reason, we cannot offer immediate emergency funds (e.g. 24 hours to avoid utilities being cut off) and ask that you allow enough time to process your request.
  • Payments will be made directly to a creditor/vendor, not to individual employees. Employees may pick up check payments at The Planning Council office to hand deliver them if desired.

Other:

  • All requests for financial assistance through the HOPE Fund will be kept strictly confidential. However, all awards must be reported on the Sentara Federal 990 form.
  • The HOPE fund does not provide loans of any kind.
  • We ask that managers or supervisors do not call to advocate for an employee to either The Planning Council or the Foundation. Input from supervisors/managers does not impact funding decisions in any way.


Additional questions regarding the guidelines should be directed to The Planning Council at 757- 622-9268 Ext. 3061
Contact The Planning Council at 
757-622-9268 or 
The Planning Council will contact you by email to confirm receipt of the application. If you have not received an e-mail within 24 hours, you may confirm receipt by calling
757-622-9268.
Employee Info
This must be your Sentara Email
Date format must be ##/##/####
Sentara Info
File size must be under 25mb
File size must be under 25mb
File size must be under 25mb
Household member
List every member of your household. Include minor children under the age of 18 in the household. Add each member with the "Add another member" link
Date format must be ##/##/####
Hardship Information
File size must be under 25mb
Requested Assistance
$
File size must be under 25mb
Contact The Planning Council at 
757-622-9268 or 

Page 3

Agreements
I UNDERSTAND THAT PROVIDING FALSE INFORMATION IS A VIOLATION OF SENTARA INTEGRITY STANDARDS AND A HUMAN RESOURCES CODE OF CONDUCT VIOLATION. FALSIFICATION OF THIS APPLICATION WILL DISQUALIFY YOU FROM CURRENT AND FUTURE HOPE FUND ASSISTANCE AND COULD LEAD TO DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION. AS SUCH, ANY VIOLATION WILL BE COMMUNICATED TO YOUR HUMAN RESOURCES CONSULTANT.
I certify that the above information is true and correct. I understand that funding will be provided based on the funds available at the time of the request. I understand all completed requests are reviewed in the order in which the H.O.P.E. Fund Review Panel at The Planning Council receives them.

Confidential Agreement and Authorization for Release of Information Agreement of Cooperation

I understand that in order to have my application reviewed for assistance addressing issues related to my current crisis, I must fully cooperate with The Planning Council staff in the process. Further, my application information will be stored in a database maintained by the Sentara Foundation - Hampton Roads and will be utilized for reporting and verification purposes.

I understand that I must supply any information and documentation requested to determine my eligibility for receipt of financial assistance. I authorize The Planning Council staff and The Sentara Foundation - Hampton Roads to obtain and convey necessary information to or from other parties in order to determine any eligibility for assistance.

I understand that unidentified data from my case may be used in future reports while maintaining my confidentiality.

I understand that failure to cooperate with program requirements and/or falsification of information can result in potential termination from employment at Sentara, loss of assistance and any future eligibility to apply.

HMIS Client Consent Form
Authorization for Release of Information

I know that this agency is part of the ShelterLink HMIS (Homeless Management Information System.) The HMIS is a system that uses computers to collect information in order to help pay for services to people at risk of, or currently experiencing, homelessness.

With this written consent, HMIS agencies that offer me services may enter, see and update basic information about me and my children including name, social security number, gender, and birth date. No restricted information about my health, medical needs, mental health or domestic violence can be shared unless I sign a separate agreement.

Other agency staff members who have signed the HMIS confidentiality agreement will be allowed to see, enter or use information kept in the HMIS system. This agency will never give information about a person to anyone outside this system without the person’s written consent, or as required by law through a court order.

Information in this system may not be used to deny outreach, shelter or housing. My decision to sign or not sign this consent document will not be used to deny outreach, shelter or housing services. I may revoke my consent at any time, in writing, and no *new* information will be shared.  This consent will end three years from today

I have a right to see my HMIS record, ask for changes, and to have a copy of my record from this agency upon written request.

Contact The Planning Council at 
757-622-9268 or 
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