Little Pink Houses of Hope

I understand that travel assistance funding is designated as restrictive use funding and as such, these funds should only be used solely to aid in my travel to and from the retreat location. All airline tickets will be made through Little Pink's corporate travel partner to receive funds. If I choose not to attend the retreat for any reason (medical, personal, crisis, family, death, etc.),  I understand that I am required to return my funding within 30 days of declining my acceptance. Funds that are returned will be used to help another family with their travel assistance needs.

Little Pink Houses of Hope, its employees, and agents are hereby authorized to obtain and discuss medical, treatment, therapy, financial, and other information relating to the applicant with the applicant’s healthcare providers, employer, and/or any other person or entity working with Little Pink Houses of Hope on the applicant’s behalf for purposes of confirming the applicant’s eligibility for the Travel Assistance Program.

Little Pink Houses of Hope may also use or disclose the applicant’s personal information as necessary to provide applicants with assistance under the program. Little Pink Houses of Hope may anonymize and deidentify applicant information and data and use such information for Little Pink Houses of Hope's own purposes, including developing aggregate reports. Neither Little Pink Houses of Hope nor any of its employees or agents will disclose any applicant identifiable information to any third party except as provided above, as required by law, or as deemed appropriate by Little Pink Houses of Hope to investigate or resolve any potential fraud or audit irregularity.