CARE CORNER REQUEST

The Care Corner request form is designed to unify and centralize requests from peers and colleagues at Morehouse School of Medicine for the following situations:

Bereavement Announcements
Notification of Emergent Situation
Lost & Found

Today's Date * +

Your name *

Your e-mail address *

Your supervisor's name *

Your supervisor's e-mail address: *

Care Corner Request - Please select one of the following requests you'd like to make: *

Bereavement Announcement

Notification of Emergent Situation

Lost & Found

Bereavement Announcement

Please complete the fields below. Sample bereavement announcement.

Name of deceased person

Please choose one:

Relationship to employee (i.e., Mother of Tony Smith)

Date of person's death (month and year will suffice if day is not known):

Memorial services details: date, time, location, phone, e-mail, and special notes

0/250 characters

Optional - Upload one (1) image of deceased (high resolution JPG, at least 300 dpi):

Notification of Emergent Situation

Please complete the fields below. Sample Notification of Emergent Situation.

Name of employee needing assistance

Phone

E-mail

Address

City

Zip Code

Brief description of emergency 🛈

0/250 characters

In-kind Donations: Please enter the items and quantity of items needed in the fields below:

CLOTHES (i.e. Ladies pants/size 10-12/5 pair)
FURNITURE (i.e., full size mattress (1), small desk (1), etc.)
OTHER - Items that don't fall within the above categories (i.e., backpack, bath towels, etc.)

In-Kind

Lost & Found

Please complete the fields below. Sample Lost & Found Announcement.

Date item was lost/found +

Brief description of item

Where was this item lost/found?

Based on your request, check the box of the recipient below (an e-mail will be automatically submitted to the person once you hit "Submit" below): *

Denise Britt (Bereavement Announcement and Emergent Notification)

Janet Dollar (Lost & Found)

Joe Chevalier (Lost & Found)

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