Application

Healing Hearts Application Process

In order to ensure an efficient process, please review some of our guidelines to ensure eligibility for our respite program. We are a small nonprofit and are trying our best to help as many people as possible while maintaining the integrity of our mission.

If you’ve already been approved, please print, sign and submit the three (3) forms below:

If you would like to nominate yourself or another family, please complete the Application for Consideration (next section).

Application for Consideration

This is not a typical vacation, it’s a time of respite, healing and intimate quality time for families in the midst of a traumatic medical crisis.  For some this could be a much needed rest before the next round of treatment, such as Chemotherapy or for others this could be precious time for family to be together before an impending death.

Please complete the form below about your family or the family being nominated. We will respond within 72 business hours.

* Your Name (required)

* Your Email (required)

* Your Phone Number (required)

* Tell us about your family (or the family you are nominating). (required)

* Why do you believe you (or the family you are nominating) should be considered for a stay at the Healing Hearts Respite House? (required)

* Indicates a required field.

The Currituck Beach Lighthouse in Corolla, NC
The Currituck Beach Lighthouse in Corolla, NC