Stay Afloat Application

Instructions

Please Review As Application Process Has Changed:

Step One: Review Eligibility for Stay Afloat Grants

Step Two: Review Important Information prior to filling out application

Step Three: Fill out Guidance Medical Stay Afloat Grant Application with necessary attachments and submit.

Step Four: After an email confirmation has been received, send the attached PDF (password protected) of your application to your healthcare sponsor for verification and submission. Your healthcare sponsor must submit the verified application to Guidance Medical for review in the same month that the application was submitted via the website in order to be eligible for review. For example, if the applicant submits via website on January 13th, the healthcare sponsor must submit by January 31st. It is encouraged to submit your application early in the month to allow time for the sponsor to submit.

Step Five: Eligible applications are reviewed the month following submission. Those chosen for funding will be awarded the month after submission. If the submitted application is not chosen for that month, it will be considered for the following two consecutive months. If after three consecutive months the application is not chosen for funding, the applicant is rejected and must submit a new application if they choose to retry the process.

Eligibility for Stay Afloat Grants:

We assist children (18 years and younger) with special healthcare needs and their families.

We define children with special healthcare needs as falling into three or more of the following categories:

1) Have one or more chronic health condition(s) associated with significant morbidity or mortality

2) High risk or vulnerable populations with functional limitations impacting their ability to perform activities of daily living

3) Have high health care needs or utilization patterns, including require multiple (3 or more) subspecialties, therapists, and/or surgeries

4) A continuous dependence on technology to overcome functional limitations and maintain basic quality of life.

Important Information

The healthcare sponsor is a healthcare provider or services provider (primary care doctor, subspecialty doctor, nurse practitioner, nurse, social worker, etc.) who can verify the child's designation with special healthcare needs. See criteria above. Please provide the healthcare sponsor's name, place of work, and contact number. The sponsor will be contacted prior to approval and disbursement of funds.

Please be sure to tell your healthcare sponsor that you are applying for the Stay Afloat grant from Guidance Medical so they can expect the verification phone call. Including a direct phone number and letter of support/verification from the healthcare sponsor on company letterhead will help expedite the process and improve chances for funding.

Grant Application Process:

Applications should be submitted through the website. A copy of application will be sent back to the submitter and that should be sent to the healthcare sponsor for verification.
The healthcare sponsor will submit the verified application to Guidance Medical. Applications will not be accepted directly from parents.
Applications must be submitted from the healthcare sponsor in the same month that the application was submitted to the website in order to be eligible. Letters of support from the healthcare sponsor can improve chances for selection.
Those applicants that are chosen for funding will be notified the following month after phone verification with the healthcare sponsor.
Funds will be disbursed 4-8 weeks after an application has been submitted for review to the parent at the address listed in the application.

Requests for grant funds may be for:

Medical costs - prescriptions, medical bills, medical supplies, durable medical equipment, etc.
Non-Medical costs - home modifications, vehicle modifications, clothing, diapers, bottles, etc.
Healthcare utilization costs - travel to medical facilities (air travel, train, bus, etc.), lodging for family (hotel, short-term rental), parking fees, etc.
Daily living costs - food, utilities (gas, electric, water), transportation (fuel)
Palliative and End of Life costs including funeral expenses
Other requests not categorized above will be reviewed on an ad hoc basis

Funds provided by Guidance Medical may be used in combination with other funding received from other entities. Funds will only be paid directly to the parent requesting the funding. Payments will not be made on behalf of the child or family.

Please provide a detailed description for the funding request. Please provide information on your child's or family's need. If the funding request is for a reimbursement or invoiced cost, please attach an itemized receipt. If it is for an anticipated cost, please provide an estimate. Those applications submitted with specific details demonstrating a clear need and how funds will be used supported by receipts and invoices will improve chances for selection to be awarded.

By submitting the application you are indicating that we have permission to discuss your child's health, diagnosis, and other confidential patient information with the person you identified as your healthcare sponsor. We only request necessary details and adhere to HIPAA guidelines to protect patient privacy. We acknowledge the importance of maintaining patient privacy and confidentiality.

Grants will be allocated up to $500 per family, per year. Those previously awarded grants must wait one full year (365 days) after disbursement to be eligible again. Requests for funds greater than $500 will require the approval of the Board and could result in delay of disbursement. Grant applications for greater than $500 are unlikely to be funded at this time.

Helping families of children with complex medical needs

Guidance Medical Stay Afloat Grant

Instructions

Please Review As Application Process Has Changed:

Eligibility for Stay Afloat Grants:

We assist children (18 years and younger) with special healthcare needs and their families.

Important Information

PLEASE COMPLETE THE APPLICATION BELOW

Helping families of children with complex medical needs

Guidance Medical Stay Afloat Grant

Instructions

Please Review As Application Process Has Changed:

Eligibility for Stay Afloat Grants:

We assist children (18 years and younger) with special healthcare needs and their families.

Important Information

PLEASE COMPLETE THE APPLICATION BELOW

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