General Scholarship Application

Jennifer Jones Fund Application 2024

For Solid Organ (Kidney) Transplant Recipients
The Jennifer Jones Veterans Transplant Fund is designed to provide financial support to a Veteran transplant recipient or candidate for the direct costs of financial hardship endured during chronic kidney disease (CKD).

Eligibility.

Applicants must be either be a Solid Organ (kidney) Transplant Recipient or Waiting for a Solid Organ (kidney) Transplant in stage 4 CKD or stage 5 end-stage renal disease (ESRD)/end-stage kidney disease (ESKD).

Requirements.

Applicants must be able to submit a letter from their physician stating their CKD stage that includes the physicians name and phone number. A letter of service in the form of a DD214 or a letter from the Commander for NG or Reserve members whom may not have a DD214 for validation of military service.

Monetary Amount.

The Veterans Transplantation Association will award a monetary amount not to exceed $500 directly to said business(s) in which was submitted by applicant in the application process showing the debt amount owed.

Submission.

Open 1 Sept 2024 | Deadline: 31 Oct 2024

*All awardees will be notified on or before the 1st of Dec 2024.

SPECIAL NOTE - THIS APPLICATION WILL NEED TO BE COMPLETED IN ONE SESSION. YOU WILL NOT BE ABLE TO SAVE WORK AND COMPLETE LATER. BEFORE YOU START, PLEASE HAVE ALL THE NECESSARY INFORMATION READY TO COMPLETE THE APPLICATION.
Personal Information*

First NameMiddle NameLast Name
Mobile Phone Number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
Home Address*

Street Address

Apt/Unit #

CityState

Zip Code
E-mail*
Enter E-mail Here
Diagnosed Date*
Diagnosed Hospital/Clinic Name*
Organ/Tissue Received (if applicable)*
Branch of Service*
End of Service*
Current LES
(For active duty applicants)
How long is your "run time"?*
What are the types of dialysis?*
Where is your AV fistula located?*
What is your target dry weight?*
In a renal diet, are you allowed dairy products?*
Complete an essay (at least 2 paragraphs) detailing “What does it mean to you, to be a veteran transplant recipient or candidate”?*
Upload*

Upload a File
Upload Physician's Letter Cancelof
Upload*

Upload a File
Upload Letter of Service/DD214 Cancelof
Upload*

Upload a File
Copy of bill(s) requesting to be paid Cancelof
If you have questions regarding any part of this application, how to complete it, or the requirements for its submission, please contact bljohnsonvta@gmail.com, subject: Scholarship.
E-Signature*
By signing (typing your legal name) in the space below, you are agreeing to have read and understood the application requirements, and that you are certifying that all information is correct and you are in fact the person completing this application. Please print for your records and retain as verification of your application.
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Jennifer Jones Fund Application 2024