Application for Financial Assistance for Death Benefits

Your Child's Basic Information

Child's First Name

Child's Last Name

Child's Date of Birth

Child's gender

Date of Death

If stillborn, gestational age at delivery

Cause of death

Please upload a photo of your child

Please Upload a Photo of Your Child

Caretakers filling out application:

Parents

Mother Father

Mother's Personal Information

Mother's First Name

Mother's Last Name

Mother's Date of Birth

Contact Information

+ Mother's Home Phone

Mother's Cell Phone

Mother's Email Address

Address

Mother's Street Address

Mother's Apt, Suite, Unit, Ect

Mother's City

Mother's State

Mother's ZIP

Housing

Mother's Housing Situation

Mother's Household Size

Mother's Employment Information

CONDITION - Is mother employed?

EM Current Employer

EM Position

EM Business Phone

EM Contact Person

Employer Address

EM Street Address

EM Address Line 2

EM City

EM State

EMZIP

Father's Personal Information

Father's First Name

Father's Last Name

Father's Date of Birth

Contact Information

+ Father's Home Phone

Father's Cell Phone

Father's Email Address

CONDITION - Do parents live in the same home?

Address

Father's Street Address

Father's Apt, Suite, Unit, Ect

Father's City

Father's State

Father's ZIP

Housing

Father's Housing Situation

Father's Household Size

Father's Employment Information

CONDITION - Is father employed?

EF Current Employer

EF Position

EF Business Phone

EF Contact Person

Employer Address

EF Street Address

EF Address Line 2

EF City

EF State

EF ZIP

Funeral Home Information

Funeral home name

Phone

Funeral Home Email Addres

Funeral Home Information Form

Funeral Home Information Upload

Income Information

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

I was referred to The Do More Foundation by...

Annual Household Gross Income

Primary job $ (per month)

Alimony $ (per month)

Government Assistance $ (per month)

Child support $ (per month)

Other (provide $ per month and explain)

Please explain how a grant from The Do More Foundation would assist your family

Income Certification

Income Certification Upload

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.

First Parent's Signature

First Signature Date

Second Parent's Signature

Second Signature Date

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.

Permission to share name and diagnosis

Yes, you have my permission to share my child's first name and diagnosis. No, you do not have my permission to share my child's first name and diagnosis.

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.

Permission to share picture

Yes, you have my permission to to use the photo I submitted. No, you do not have my permission to share the photo I submitted.

Application Requirements

Please complete all areas on the application. Fields not required are marked as optional.
Make sure you have downloaded and filled out the Funeral Home Information Form (this will be linked to the pdf so it can be downloaded directly from this page… no need to send them elsewhere).
Please allow 48 hours for your application to be processed

Frequently Asked Questions

Are you able to help pay for my child’s cemetery costs?

Yes. We can assist with the funeral home expenses or cemetery expenses.

Can you help me negotiate a lower funeral cost?

Yes. Sometimes, when a funeral home knows that a non-profit is helping with the cost, they will supply additional discounts.