GRANT APPLICATION CHECK LIST

What you need to apply

There are some things you will need in order to apply for the grant.

  1. PLEASE NOTE- the recipient of the grant MUST be having the IVF procedure done with a local practicing physician in ORANGE COUNTY CALIFORNIA or MISSISSIPPI.
  2. A personal story (maximum 1500 words). Do NOT document your fertility history here. We want to know who you are- hobbies, profession, family history, why you would be a worthy candidate. You may include a photo but no more than 2 please.
  3. A completed application and current medical evaluation signed and dated by your physician.
  4. A copy of your and your partner’s insurance card.
  5. Application fee of $25. All application fees with be used to offset the costs of administration fees and the back ground check of the chosen recipient.
  6. Fertility clinics and physicians may require weeks to complete the medical form. Please allow your doctor enough time to complete the form- your application is not complete without this form.
  7. Please do NOT include medical records.

Next Step

Prepare and start with the Simpson Family Grant Application