Burial Services Form

Name: *

To be eligible for burial assistance, the adult and/or child client must have sickle cell disease and be a resident of Davidson County or Shelby County, Tennessee.

The sickle cell adult client/guardian must present a valid picture ID to receive the burial assistance.

The sickle cell client consumer/child’s guardian must present the funeral home agreement.

Each client can receive a maximum of up to $500.00 per calendar year. Funds are distributed on a first come first serve basis. Funds will be distributed directly to the funeral home.

These funds shall be used as the payer of last resort; therefore, clients must exhaust other community resources prior to receiving burial assistance through The Sickle Cell Foundation of Tennessee (SCFT). Proof shall be presented in the form of denial letters from those community agencies.

Please upload all relevant files here.

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Referred by: *

I clearly understand the Burial Assistance policy and agree to the aforementioned guidelines. *