Project C.U.R.E.

We identify, solicit, collect, sort and distribute medical supplies and services according to the imperative needs of the world

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Get Assistance Application

Applicant or Organization Making Request

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Name of Applicant/Organization (required) First Name (required) Last Name (required) Address (required) City (required) State (required) Country (required) Zipcode/Postcode (required) Phone Number (required) Email Address (required) Mobile Number (optional) Fax Number (optional) Web Address (optional) How Did You Hear About Us? (required)

Expected Recipient/End-User of the Requested Assistance

Primary Assesment Site Name (required) Hospital/Clinic (required) Address (required) City (required) State/Province (required) Country (required) Zipcode/Postcode (required) Phone Number (required) Fax Number (optional) Mobile Number (optional) Other Number (optional) Email Address (optional) Number of Potential Other Sites (required) Specific Known Needs (required)

Assessment Study Host/Contact Information

Host/Contact Person On Location (required) Position (required) Address (required) City (required) State/Province (required) Country (required) Zipcode/Postcode (required) Phone Number (required) Fax Number (optional) Mobile Number (optional) Other Number (optional) Email Address (optional)

Sponsor of Financial Arrangements

Who Will Pay For The Assessment? (required) Who Will Pay For The Cargo Project? (required)

Official Request For Assistance

I am hereby making a formal request for assistance from project C.U.R.E. on behalf the requesting organization to be used at the receiving hospital detailed above.

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