Application for Financial Assistance

Your Child's Basic Information

Child's Date of Birth & Gender
Please Upload a Photo of Your Child
Please select the child's current caretakers:

Mother's Personal Information

Mother's Date of Birth
Contact Information
Address
Housing

Mother's Employment Information

Employer Address

Father's Personal Information

Father's Date of Birth
Contact Information
Address
Housing

Father's Employment Information

Employer Address

Information Related to Child's Diagnosis and Treatment

Social Worker
Treating Physician(s)
Treatment

Grant Request Information

Please describe the specific financial need you are seeking help with:
Source of other financial assistance:

Income Information

For all files other than "Annual Household Gross Income" - Leave field blank of the amount is "0"
Income Certification

Application Agreement

I hereby apply for assistance from The Do More Foundation to assist with expenses related to the chronic illness of my child. I attest that the information contained in this application is true and accurate. I authorize The Do More Foundation to obtain information from our my Doctors or employer to verify the information above that is pertinent to the application and grant request. I understand that any information that is falsely submitted will disqualify me from receiving financial assistance from The Do More Foundation.

Permissions

Our grants are made possible by donors who give to help families just like yours. We would like your permission to share your child's first name and diagnosis with our supporters and/or prayer partners, so they have the opportunity to help sponsor your grant. No other personal information is shared.



I authorize The Do More Foundation to use my submitted photograph, if needed, to educate the public about the organization and its services. I understand that our personal information will not be used, only the picture.

Photographs will only be used if your family is awarded a grant.

Application Requirements

  1. Please complete all areas on the application. Fields not required are marked as optional.
  2. Make sure you have included the name and phone number of the Physician and Social Worker.
  3. Please submit a current picture of the child with the application and history form filled out.

Frequently Asked Questions

No. We are not a diagnosis specific organization so we can help children facing anything from cancer to an illness brought on by an accident.

The grants vary from person-to-person based on a variety of factors, including how much grant money is available for distribution.

Yes. We understand that a child’s medical needs often continue creating other financial needs. We welcome a family to apply more than once for a grant.

 Yes. Sometimes we are able to work directly with a company to pay an outstanding bill on your behalf.