Request Assistance

A Few Things You Should Know:

  1. The Can't Never Could Board application committee typically reviews submitted applications on the second Monday of every month.
  2. To allow enough time to review, process, and copy your application, the CNC application committee must have it submitted by the end of business on the 1st day of each month.
  3. Late applications will be considered at the meeting on the following month.
  4. Applications that meet CNC criteria (based on annual goals) will not be reviewed until provided references are received.
  5. The committee will accept only one application per patient every six months.
  6. Please insure that the entire application form is completed. Incomplete forms will take longer to process.
  7. Each request is reviewed individually.
  8. The amount of assistance granted will depend on the amount of funds available, the medical diagnosis, and the financial needs of the applicant.
  9. Submitting an application does not guarantee you will receive funds.
  10. CNC does not pay funds directly to the applicant. Funds are paid to applicant's creditors directly once the application is approved by the application committee.
  11. CNC is a nonprofit corporation working under the umbrella of the Coweta Community Foundation.
  12. By submitting an Application for Assistance, the applicant is certifying that all information provided is complete and accurate to the best of their knowledge. They also understand that Can't Never Could, Inc. is not required to render any assistance to the applicant or patient and that they must remain responsible for payment of bills. By accepting an application, CNC has assumed no responsibility for payment of any bills.
  13. Applicant must provide a Doctor's report verifying the Patient's diagnosis. This can be scanned and attached to the application, emailed to cantnevercouldinc@gmail.com or mailed to 10 Sherwood Drive, Newnan, GA 30263.

Patient

Submitted By

Situation

Family

Employment



Miscellaneous

Sources of Income (List MONTHLY amounts)

ItemApplicantSpouseOther
Net Wages (after taxes)
Unemployment
Sick Pay
Social Security
Short/Long term disability
Retirement Benefits
Rental Income
Interest Income
Alimony
Child Support
Trust Funds
Room/Board
Welfare
Military Benefits
Other

Expenses (List MONTHLY amounts)

ItemApplicantSpouseOther
Rent or Mortgage
Home Heating (non-electric)
Electric
Water, Sewer and Trash
Home Phone & Cell
Car Payments
Car Insurance
Gasoline
Food
Health Insurance
Life Insurance
Child Care
Internet and Cable