Apply for Support

Request aid from Clemy’s Crew using the forms below. We will respond as soon as possible.

PLEASE CAREFULLY READ THE FOLLOWING INFORMATION

• Clemy’s Crew,INC. does not discriminate against or deny aid because of your race, religion, color, national origin, sex, political affiliation or any other protected category under state or federal law.

• Your application will be reviewed on a case-by-case basis. A final determination for financial assistance is subject to availability of funds and adherence to Clemy’s Crew,INC. guidelines.

• The information provided to Clemy’s Crew,INC. will be used solely for the purpose for which it was provided and will be kept confidential.

• Clemy’s Crew,INC. does not have any agreements with medical providers to refer patients to providers, nor would Clemy’s Crew,INC. be willing to enter into any such agreement. Clemy’s Crew,INC. cannot and will not provide advice to our clients concerning (1) what treatment to pursue; (2) from which medical providers to seek treatment; (3) insurance coverage for treatments prescribed and/or received; or (4) any other decision affecting the health and/or medical treatment of our clients.

• Clemy’s Crew,INC. cannot and will not provide tax or legal advice.

Applications for aid and other forms are found below:

Request or Refer Someone For Support: