First Name *Last Name *Email Address *Phone *Please indicate which type of Bereavement Support Request this is: *Self-requestCommunity member nominationFamily/Friend nominationWhat 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 MotherIndividual with Down syndrome FatherIndividual with Down syndrome siblingIf the family member that passed away is not the individual with Down syndrome, could you kindly tell us that individuals name,Date of passing *What type(s) of supports would be most benefical to your family at this time? *Assistance with funeral expenses are required, excluding costs for the casket or burial?Grief counseling supportBereavement support team contact for emotional supportGrocery delivery for familyMeal Train set-upDSAU Bereavement CardBereavement gift/memorialHouse cleaning servicesLaundry servicesIs it okay for us to reach out to offer additional support? *YesNoWould you like us to inform the DSAU community, or would you prefer to keep this private? *Inform communityPrivateWould you like a prayer request created? *YesNoWould 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?Send MessagePlease do not fill in this field.
