Grant Application

9/19/24: Current Applications are for Arizona Residents only, although your clinic can be in any state! Thanks to the incredible support from our recent golf tournament event, the Arizona Chapter has raised funds to open applications for IVF grants.

PLEASE READ!

Eligibility: In order to be considered for a grant, couples must complete the application, write a detailed history about fertility issues, and allow the foundation to share their story with media personnel if they are selected. Applicants must demonstrate overall good physical and mental health, and show financial stability including basic health insurance for mother/prenatal care, adequate living arrangements and means for child support. 
 The grant amounts will be dependent on fundraising efforts the previous year.  While we would love to offer grants to every applicant, not all applicants will receive grants. The grant amounts vary among the grant recipients, and partial and full grants can be awarded. What is covered (i.e. monitoring, lab work, medications, procedures, etc.) under the grant amount will be disclosed to each of the grant recipients at time of award and funds from the grant will be given directly to the clinic.  The funds from the grant will be available to the recipients for a period of twelve months. The grant can be used toward fertility treatments at any fertility clinic that is a member of the Society for Assisted Reproductive Technology (SART). 

SUBMISSION CHECKLIST:

To apply for a grant, you must submit the following information with your completed application:  
 
1.  Complete application.  Write N/A (Not Applicable) if the question does not apply to you.  Do NOT leave it blank. ALL fields MUST be filled in.
2.  A personal statement indicating why you (and your spouse) have chosen to apply for a SIF grant. Include information about your efforts to conceive, your financial circumstances, and why you feel you would be a worthy candidate. Photos are welcomed, but not mandatory.  
3.  Signed release form (below) giving SIF permission to use your story. 
4.  Application fee of $50. This fee is NONREFUNDABLE. Paypal or Credit Card only.  
5.  Application MUST have a signature(s) 
6.  ALL APPLICATIONS MUST BE IN OUR HANDS BY THE GRANT DEADLINE. NO LATE SUBMISSIONS WILL BE ACCEPTED.  

Have you ever been convicted or pled guilty to a felony or misdemeanor?  If yes, please give the date of the offense, the charge, and the outcome.

The Applicant and Co-Applicant hereby assigns and grants the Starfish Infertility Foundation (Organization) and its legal representatives the irrevocable and unrestricted right to use excerpts in whole or in part from their personal statement for editorial, trade, advertising, or any other purpose and in any manner and medium; to alter the same without restrictions; and to copyright the same. They hereby release the Organization and its legal representatives and assigns from all claims and liability relating to said excerpts. Any person mentioned in this personal statement shall be deemed to have consented to the use of their name, image, or likeness by Applicant/Co-Applicant and/or Organization and Applicant/Co-Applicant shall defend and indemnify the Organization from and against any claims that any of Applicant/Co-Applicant's friends, family or other persons mentioned in the personal statement may assert against the Organization arising from, or related to, the use of any name, image, or likeness of Applicant/Co-Applicant's friend, family or other person mentioned in the personal statement by Organization. Surnames will NOT be used so as to protect the identification of any of the above.