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The Ann Maree Memorial Carpe Diem Fund

The purpose of the Ann Maree Memorial Carpe Diem Fund is to enhance the lives of adults with any life-threatening medical condition by providing adventures and experiences that enrich their lives. Grants are given for adventures and experiences such as meeting someone you've always admired, doing something exciting or adventurous, or "being someone" for a day. The Ann Maree Memorial Carpe Deim Fund pays for fun experiences for adults (ages 19 and over) who have a life-threatening medical condition.

To be considered for a grant from this fund, complete and submit the following form electronically. Applications are reviewed year-round.

Applicant Name: 

Prefix
First
MI
Last
Suffix
 
 
 
 
 

Street Address:
 

Address 2 (optional):
 

City:  

State:   Zip Code:  County:  

Home Phone Number:  

Email address:  

Medical Condition: 
 

Prognosis: 
 

Attending Physician Name: 
 

Attending Physician Street Address:
 

Attending Physician Address 2 (optional):
 

Attending Physician City:  

Attending Physician State:   Attending Physician Zip Code:  

Attending Physician Phone Number:  

Attending Physician Email address (if known):  

I give permission for Berks County Community Foundation to contact my physician and give my physician permission to release information about my condition and prognosis to Berks County Community Foundation:

Yes
No
 

Please describe the adventure or experience you are hoping for and why:

 

Note: Berks County Community Foundation employees, board members and/or committee members are not eligible to apply for or receive a scholarship offered by Berks County Community Foundation, nor are their immediate family members. However, immediate family members are eligible to be nominated and recognized as the recipient of a scholarship, but without the financial award of the scholarship. Immediate families include spouses, children, stepchildren, grandchildren, stepgrandchildren. The ineligibility period for Berks County Community Foundation board members or employees extends five years after board service or employment terminates. The ineligibility period for committee members who are not Berks County Community Foundation staff or board is in effect only during their term of service.