CARRYWELL Family Growth Grant Application

Family Growth Grant Application
Thank you for inviting CARRYWELL into your fertility journey. We are honored to be able to support couples financially and give the gift of hope.

Below you will find the required information and documents to complete this application. Once you start the application you are able to save and finish later. You will receive an email with a link to use when you are ready to continue the application.

Last day to submit an application is 11:59 PM CST on November 29, 2025. See details below.

Required Information and Documents:
- Marriage Certificate
- Proof of Legal U.S. Residency
  - birth certificate, passport, visa, or other form of accepted documentation establishing the applicants’ legal residency status
- Wife & Husband's Medical History and Lab Results
- Monthly Budget
- W2 and/or check stub for husband & wife
- Tax Return
- Two Months of Bank & Credit Card Statements
- Background Check Authorization
- Acknowledgement Form
- Fertility & Faith Journey Submissions
*Do Not take a picture of the supporting documents with your phone camera or by screen shot. They are too small to read. Turbo Scan is a great application allowing you to take pictures of your documents using your phone, save individually or combine into one pdf. You can then email the pdf to yourself through the app, save on your computer and upload to the Grant application.

Disqualifying Factors:
- Incomplete application/missing documents/documents that are not combined or illegible
- BMI greater than >39 kg/m2
  - CARRYWELL Grant - Health Benefits
- Smoking(positive cotinine levels)/Vaping/Juuling/Illegal Drug Use
  - CARRYWELL Grants - Health Benefits
- IVF for female over age 40 (all procedures must be performed prior to the wife’s 40th birthday)
- Lack of commercial insurance (no Medicaid or Medicare)
- Misrepresentation of information
- Failed background check
- Illegal U.S. resident
- Failure to properly redact names on documents notated below
CARRYWELL knows the importance of a strong marriage as you take this next step to growing your family. Marriage is a important, in fact, it is the second most important relationship you have after your relationship with God. As part of our mission and commitment to you, CARRYWELL has written a marriage curriculum, Waiting Faithfully Together, focusing on communication with our spouse, navigating our emotions, reevaluating our motives, and how to cope with the waiting. This is an eight week group where you will be surrounded by other couples walking a very similar journey creating a community that will help carry you through this season. If you receive the Grant both spouses will be required to attend 75% of the group meetings. The group will be virtual and start Monday, August 18 at 7 PM CST for 8 weeks.

Who can apply and what is covered?

It has always been part of heart and mission to financially bless couples desiring to grow their family. CARRYWELL is excited to be able to support couples no matter where their Fertility Clinic is located!

If you choose to use one of CARRYWELL's Medical Partners the average grant covers $6,000 of the grant recipient's fertility treatment. This is possible through our Medical Partner's matching program.

If you choose not to use one of our Medical Partners the average grant is $3,000 for the grant recipient's fertility treatment.

To prevent all bias, an anonymous Grant Committee has been selected to review and award the Grants. No member of the ministry staff has any influence on the decision making process. Once the couples have been selected, they will receive a phone call from the Executive Director of CARRYWELL.

The amount of each grant awarded is at the discretion of our anonymous Grant Committee. All payments will be made directly to the Fertility Clinic.

Procedures Covered:
- Traditional IVF
- INVOcell
- Cryo-embryo Transfers
- Embryo Adoption
The patient is responsible for any travel expenses and additional charges/procedures deemed necessary by their medical providers including but not limited to: the initial consultation with the provider (husband and wife), additional laboratory/medical screening deemed necessary by the provider, cycle monitoring, medications, cryopreservation of sperm (if necessary), surgical extraction of sperm or eggs (if necessary), cryopreservation of embryos in excess of those transferred (as appropriate), pregnancy tests, pregnancy monitoring and ultrasounds. Your health care provider will discuss additional necessary procedures prior to your enrollment in an IVF treatment cycle. Medical care and/or decisions on treatment reside with the Medical Provider. The Grant funds are paid directly to the Medical Provider.

Recipients have 6 months to use the grant proceeds from the date a Family Growth Grant is awarded after which point in time the Grant funds will be released and used at CARRYWELL's discretion.

If the recipient becomes pregnant before the Grant is utilized the funds will be held until the mother is 12 weeks in utero. At that time, the Grant funds will be released and used at CARRYWELL's discretion.

Medical Partners:

Our Medical Partners are important to us but we don't want geographic or travel contraints to limit grant access. Grants can be applied to any Fertility Clinic though matching options are limited to our Medical Partners.

Covered Fertility Treatments through our Medical Partners:

Innovative Fertility Specialist is located in Birmingham, AL, and specializes in INVOcell. The Grant covers one cycle of INVOcell up to $6,000 or one cryo-embryo transfer up to $3,500. IFS Website

Alabama Fertility is located in Birmingham, Huntsville and Montgomery, AL, and specializes in traditional IVF. The Grant covers one IVF treatment up to $6,000, which is partial coverage, or one Cryo-embryo transfer up to $3,500. Alabama Fertility Website

National Embryo Donation Center (NEDC) and Southeastern Fertiliy Center is located in Knoxville, TN. NEDC is a non-profit specializing in embryo adoption and donation while Southeastern Fertility Center is the medical practice performing the embryo transfer. The Grant covers the NEDC's program fee of $2,500, if applicable, and Southeastern Fertility Center's medical fees associated with the embryo transfer of $3,500, which is partial coverage. NEDC Website | Southeastern Fertility Center Website

Applicant Information
Wife's Full Name*

First NameLast Name
Wife's Phone Number*

Area CodePhone Number
Wife's Email *
example@example.com
Wife's Occupation*
Husband's Full Name*

First NameLast Name
Husband's Phone Number*

Area CodePhone Number
Husband's Email*
example@example.com
Husband's Occupation*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Marriage Certificate (Name Document "Marriage Certificate")*

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Proof of Legal U.S. Residency (Name Document "US Residency")*

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Ex. Birth Certificate, Passport, Visa, or other form of accepted documentation Cancelof

Financials
Please complete the chart below, providing your household budget for a typical month. It is important to have this information for the review process to best understand your needs and challenges. This information will not be shared with anyone outside of the Grant Committee.
Household Annual Income (combined adjusted gross income)*

Household Budget

	Average Cost/Monthly
Mortgage/Rent
Homeowners Association Dues
Utilities (Water, Gas, Electric, Trash, Cable, etc)
Phone
Car Payment
Fuel
Credit Cards
Education Loans
Child Care
Groceries
Dining Out
Entertainment
Fertility Treatments
Other - 1
Other - 2
Other - 3
Total

If you entered an amount for "Other" please explain:
Other -1 Other - 2 Other - 3
How much have you spent out of pocket on past fertility treatments? medication, IUI, IVF, etc.
If you are applying for a partial grant for traditional IVF or embryo adoption, how do you plan to pay for the additional expenses?
What is your current balances of your saving and checking accounts?
Bank Name
Checking 1      Savings 1

Bank Name
Checking 2      Savings 2
Please include the two most recent months of bank and credit cards statements for all accounts.

We take every precaution to eliminate any bias and protect your sensitive information. Please redact your names, account numbers, employer, address, or any identifiying factor from each statement, W2 or paycheck, and tax return before uploading. Failure to do so can lead to disqualification. Then, combine the two month's statements and combine into one document using the naming convention below.

You can upload up to three bank, saving and credit card accounts. Include the most recent two months of statements per account, remember combine the two months into one document. If you have more accounts per category, please email support@carrywell.org.

DO NOT take a photo of your bank statements with your phone's camera. Either download your statement directly from your online account or use the app Turbo Scan. If the documents are not legible your grant may be disqualified.
Bank Statement - 1 (Name Document "Bank Statement - 1". (Combine and attach two most recent months)*

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Bank Statement - 2 (Name Document "Bank Statement - 2". (Combine and attach two most recent months)

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Bank Statement - 3 (Name Document "Bank Statement - 3". (Combine and attach two most recent months)

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Credit Card Statement - 1 (Name Document "Credit Card Statement - 1". (Combine and attach two most recent months)

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Credit Card Statement - 2 (Name Document "Credit Card Statement - 2". (Combine and attach two most recent months)

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Credit Card Statement - 3 (Name Document "Credit Card Statement - 3". (Combine and attach two most recent months)

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W2 or Check Stub for Husband and Wife (Name Document - "W2 or Check Stub"). Attach most recent and combine for both husband and wife if applicable)*

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Tax Return (Name Document - "Tax Return". (Attach most recent and combine Husband and Wife if applicable)*

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Fertility & Faith Journey
Write your fertility and faith journey for you and your spouse, and include the reason for your request of financial assistance. This is a way for us to understand your journey. If you need to further explain any of the information shared in the application you can do that here.

This can be a collaboration of both within one storyline or you can separate the husband and wife's journey.

As mentioned before, we take every precaution to eliminate bias. Please DO NOT include names in this submission.
Fertility & Faith Journey (Name Document "Fertility & Faith Journey"). If both Husband and Wife are submitting a separate submission please combine into one document and attach.*

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Confidential Background Check Authorization
I hereby affirm that the information contained in this application is correct to the best of my knowledge. I hereby authorize CARRYWELL and/or its designated agents and representatives to conduct a comprehensive review of my background to include a federal and state criminal background check that will be generated for the purpose of informing CARRYWELL that the Grant candidate is qualified to be awarded a Grant by the committee. I understand that the scope of this background check may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency (including but not limited to any law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to CARRYWELL or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release and hold harmless CARRYWELL, and its agents, officials, representatives, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.
Husband's Name*

First NameLast Name
Husband's Signature*

Clear
Date*
Wife's Name*

First NameLast Name
Wife's Signature*

Clear
Date*

Acknowledgement Form
I, First Name* Last Name* and First Name* Last Name* have read all the qualifications required to apply for assistance from CARRYWELL and hearby acknowledge that all the information supplied in this packet is true, accurate and correct. I understand that false statements may disqualify me from receiving a Grant.
Wife's Signature*

Clear
Date*
Husband's Signature*

Clear
Date*

MonthDayYear
Date
I acknowledge and agree that I will receive my fertility treatments from a CARRYWELL Medical Partner, and will pay for any necessary and/or additional expenses not covered.
I acknowledge and agree that I will pay for any necessary and/or additional expenses not covered by the Family Growth Grant.
Wife's Signature*

Clear
Date*
Husband's Signature*

Clear
Date*

MonthDayYear
Date
I acknowledge and agree that I will participate in a CARRYWELL marriage group, Waiting Faithfully Together, and attend 75% of the meetings.
Wife's Signature*

Clear
Date*

MonthDayYear
Date
Husband's Signature*

Clear
Date*

MonthDayYear
Date

Communication & Marketing Consent
Our generous donors who make this Grant possible want to hear from you! Nothing fills their cup more than hearing how the Family Growth Grant brings hope and change to the lives of recipients. We know we cannot control the outcome but being able to know the impact of the Grant is so important for the donors, CARRYWELL's team, and for you!

Please read the below required communication and marketing commitments.
Will you agree to allow CARRYWELL to use part or all of your Fertility & Faith journey included in this application to increase awareness?*

Yes, I agreeNo, I do not agree
Will you agree to notify CARRYWELL of upcoming appointments and results? We not only want to know how your process is going, but we also want to be able to pray for you! Send an email to mallory@carrywell.org BEFORE these milestones: Initial Consultation, Egg/Sperm Retrieval, Embryo Transfer, Blood Pregnancy Test, Results of Blood Pregnancy Test*

Yes, I agreeNo, I do not agree
Will you agree to send CARRYWELL an email describing how the Grant has impacted your life with a picture together? Send email to hallie@carrywell.org after these milestones: After receiving the Grant, after Embryo Transfer, after Blood Pregnancy Test.*

Yes, I agreeNo, I do not agree
Wife's Signature*

Clear
Date*

MonthDayYear
Date
Husband's Signature*

Clear
Date*

MonthDayYear
Date
Upload a picture together.

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Should be Empty:

	Full	Partial	None
IVF
Medication
Other Fertility Expenses

	Full	Partial	None
IVF
Medication
Other Fertility Expenses

Family Growth Grant Application

Applicant Information

Application Information

Medical Form

Wife's Medical Form

Husband's Medical Form

Financials

Fertility & Faith Journey

Confidential Background Check Authorization

Acknowledgement Form

Communication & Marketing Consent