Bereavement Fund – Down Syndrome Association of the Upstate

First Name *

Last Name *

Email Address *

Phone *

Please indicate which type of Bereavement Support Request this is: *Self-requestCommunity member nominationFamily/Friend nomination

What is your relation to the family? *

Name of Individual with Down Syndrome *

Did this individual pass away? *YesNoOn behalf of the Down Syndrome Association of the Upstate, we extend our heartfelt condolences to you and your family during this difficult time. Please know that our community is here to support you, and you are in our thoughts.

We are here to support you during this difficult time. To better understand your loss, could you kindly let us know who in your family has passed away? This will help us offer the most appropriate support and condolences. *Loved one with Down syndromeIndividual with Down syndrome Motherndividual with Down syndrome Fatherndividual with Down syndrome sibling

If the family member that passed away is not the individual with Down syndrome, could you kindly tell us that individuals name,

Date of passing *

Would you like us to inform the DSAU community, or would you prefer to keep this private? *Inform communityPrivate

Would you like a prayer request created? *YesNo

Would you like to share any other information about your loved one?Completing this field allows for further customizations of bereavement gifts and memorials.

Would you like to share service details so members of our DSAU Board can be in attendance?