Application

Please fill out the application below and someone from our team will

follow up with you within one to two business days.

Application Form

First Name *

Last Name *

Email Address *

Phone

What kind of help do you need? *

Message

Preferred Contact Time

Did you suffer the loss of a loved one due to Covid?

How old were you when your parent(s) or guardian(s) died?

Please explain how your parent(s) or guardian(s) passed away suddenly, if not from COVID-19.

Comment specifically about your (and your family's) experience with COVID-19.

How did you first learn about Covid Foundation US?

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Covid Foundation US is a 501(c)(3) and all donations are tax-deductible. EIN 88-3762907

Box 323,
Harbor City CA 90710, United States.