Fore Hadley’s Angels in the NICU Grant Application

PURPOSE

The purpose of Fore Hadley Angels in the NICU grants are to assist current and future families dealing with a CDH diagnosis, by providing financial contributions to assist those families with the costs associated with medical care expenses, extended long distance travel, and living arrangements. Costs that are often a must to ensure access to the proper specialty care needed by CDH babies. Funds may be used for costs such as travel expenses (air travel, gas, hotels, rental cars, etc.), medical or diagnostic appointments/studies, supplies while away, etc.

GRANT AWARDS

Fore Hadley Angels in the NICU grants are awarded on the basis of a comprehensive review process. Financial grants are awarded on a rolling basis and are granted on merit without regard to race, religion, creed, sex, national origin, sexual orientation, or disability status.

Upon review and acceptance of your application, all Fore Hadley Angels in the NICU Grants are for a value of $500.00. Whether granted or declined, applicants must wait (1) calendar year before reapplying.

GUIDELINES

We accept applications for Fore Hadley Angels in the NICU grants on a rolling basis throughout the year.
Please complete the grant application below in it’s entirety for consideration and attach pictures via button or email to info@forehadley.com.
We will try do our best to make a decision on your application within 14-21 days. You will be notified by email once a decision has been made.
If you have any questions about the application, please email Katie Bush, info@forehadley.com

APPLICATION

Name

First Name

Last Name

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth or Expected DOB of CDH Child

MM

DD

YYYY

Gender of CDH Child

Female

Male

Description of Request (300 Word Limit)

Please provide us a brief description of your current situation, and a high-level overview of how funds would be put to use. Any additional background you think would provide us extra perspective please also list here.

Disbursement of Funds

Upon approval, please indicate how (mailing of check, PayPal, etc) and when funds would need to be disbursed to you as the grant recipient.

Agree to Submit Photographs/Story

The continued funding of the Fore Hadley Angels in the NICU Fund is only possible via the sharing of "Stories of HOPE" provided by previous grant recipients to help raise awareness and contributions. As such, Fore Hadley now requires the submission of 2-3 pictures of child/family and applicant's choosing alongside your application. Preferably (albeit not required), a brief "Story of HOPE" - 2-3 paragraphs - would accompany photos for posting on the Fore Hadley Foudation website - www.forehadley.com/our-stories. Photographs and narratives can be provided via the button directly below the application or sent via email to info@forehadley.com. Thank you for helping us to keep this fund available for future CDH families in need!

Yes

No

Statement of Accuracy for Application

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that if chosen as a grant recipient my picture or one of my CDH child may be taken and used to promote the Fore Hadley Foundation’s ongoing mission of providing support for other future CDH babies and families. (Recipients may waive photo due to unusual or compelling circumstances.) I hereby understand I will not submit this application without all required attachments and supporting information.

Confirm

Application Date

MM

DD

YYYY

Angels in the NICU Application

Fore Hadley’s Angels in the NICU Grant Application