FOR CLSCs LAC-ST-LOUIS AND PIERREFONDS PROFESSIONALS ONLY
Identification of the person initiating the request
Name of health professional
Name of program and directorate
Reason for the request
Have you ever requested help from the foundation for this client?
If yes, please justify this new request
Since the Foundation is a last resort for funding, what other sources have been approached?
Results of the financial research
Reason of the refusal
Program Manager Name
All requests must be forwarded to the Board of Directors
: CLSC du Lac-Saint-Louis, 180, avenue Cartier, Pointe-Claire, Québec H9S 4S1
Invoices must be emailed or mailed to the same addresses.