GRANT APPLICATION CHECK LIST
What you need to apply
There are some things you will need in order to apply for the grant.
- 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.
- 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.
- A completed application and current medical evaluation signed and dated by your physician.
- A copy of your and your partner’s insurance card.
- 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.
- 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.
- Please do NOT include medical records.
Prepare and start with the Simpson Family Grant Application