The Skylar Project Financial Assistance Application Form

The Skylar Project Financial Assistance Application

This program is designed for families seeking financial assistance with an infant in or recently graduated from the NICU at USA Children's and Women's Hospital.
- Applicant must reside in Alabama
- 1 award per family
- Awards granted upon evaluation on a first-come, first-served basis
- Assistance will be rewarded until available funds are exhausted
- Applicants must be verified by a social worker
- Applicant must have a baby currently or recently in the NICU
- Application does not guarantee that anyone will receive a payment or benefit
- The Skylar Project is not responsible if receiving these funds precludes an individual from receiving funds from another source
Parent or Guardian Name*

First NameLast Name
Baby's Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your baby currently or recently in the NICU?*

YesNo
Have you already applied for financial assistance with The Skylar Project?*

YesNoI don't know.
How will this resource be helpful to you and your family?*
Social Worker Name*

First NameLast Name
Social Worker Phone Number*

Area CodePhone Number
Social Worker Email*
example@example.com
Would you like to share your NICU journey?*
If so, do you give The Skylar Project permission to share your story to bring awareness?*
If funding is awarded, how do you prefer to receive the funds?

CashappChevron Gas CardBill PayOther
Have you been issued a security code?*

YesNo
Input code here:*
Date*

MonthDayYear
Date
Signature*

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www.theskylarproject.org

Our mission is to provide resources for NICU and bereaved families, offering financial assistance, care packages, mental health advocacy and support.
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