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*A representative from Medina Cares will contact you,

verify information, and discuss your specific needs and

your request.

*All requests are then submitted to the Board of Directors

for discussion and approval if funds are available.

*A representative from Medina Cares will then contact you

with the Board's recommendation.

*If approved, a check will be issues to the specific

company providing services.

No checks are written directly to the individual.

*Additional community resources and referrals will

also be discussed.

 
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1114 North Court  St.
Box 122
Medina, Ohio 44256

Questions: Call (330) 461-0718  leave a message.

 

Submission of application:  Upon completion of the application, mail to the above address (see forms page for application).

Only one application per resident will be granted within a 1 year period.


You should hear from someone within 1 week.

 
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1114 North Court St.
Box 122
Medina, Ohio 44256




Financial Assistance Application


Your Name:               ____________________________

Address:                   ____________________________

Date of Application:   ____________________________
Referral Source:         ____________________________
Phone Number:          ____________________________
Age:                            _______


Situation: (Describe current medical crisis)

___________________________________________________________________________________________________

___________________________________________________________________________________________________


___________________________________________________________________________________________________


___________________________________________________________________________________________________


Name and Address of company providing service or equipment :

___________________________________________________________________________________________________


___________________________________________________________________________________________________



Phone Number and Contact information for check:

___________________________________________________________________________________________________


Amount of Request:  $______________

 
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                1114 North Court  St.
                Box 122
                Medina, Ohio 44256             


Mission:  To provide temporary financial assistance once annually and community resources to help meet the needs of persons in Medina County ages 19 t0 59 years old who are experiencing a medical crisis.

Qualifications:  The qualifications for someone to be considered to receive financial assistance through Medina Cares are as follows:

1.    Medina County Resident

2.    Age 19 to 59 years old

3.    In financial need of an item or service

4.    Money will be paid to provider of service or equipment (i.e. prescriptions, equipment, utilities…, etc.)

5.    Individual experiencing a medical crisis.

6.    Only 1 request will be granted per individual in a 1 year period.




Submission of application:  Upon completion of the application, mail to the above address (see forms page for application).
 

         You should hear from someone within 1 week.