Stay Fit Grant Application

Stay Fit Grant Application
At this time, Fight CF Foundation Stay Fit Grants are only available to cystic fibrosis patients who receive care at Children's Hospital of The King's Daughters in Norfolk, VA or Naval Medical Center in Portsmouth, VA.

Stay Fit Grants are up to $250 annually per patient with cystic fibrosis. Typical use of these funds include things like sports leagues and clubs, sports equipment, coaching, gym memberships, etc. Upon application approval and verification of CF diagnosis, Fight CF will make payment directly to your chosen sports league or reimburse qualifying sports equipment expenses.
Cystic Fibrosis Patient Name*

First NameLast Name
Patient Date of Birth*

MonthDayYear
Date
Which best describes you in relation to the CF patient?*

Self/CF PatientParentGrandparentLegal GuardianOther
Primary Caretaker Name*

First NameLast Name
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Patient's Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell us about your CF Care Center
Care Center Name*
City, State*
Coordinator/Social Worker *
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Fight CF Foundation requires verification of the patient's CF diagnosis from your CF Care Center. Please obtain a letter from your CF Care Center with the patient's name, date of birth, and verification of thier diagnosis.

Verification letter can be emailed to grants@fightcf.com or text to (757) 705-0014
Tell us how we can help you stay fit!
Please provide a brief summary letting us know how you would like to use these grant funds to stay fit (minimum 25 words required)*

0/0
How were you referred to us?*

CF Clinic StaffDoctorFamily/FriendCompassOther
Has anyone else applied for this grant on behalf of this CF patient?*

YesNo
Is the CF patient related to a Fight CF Foundation board or staff member?*

YesNo
Fight CF Foundation Stay Fit Grants are limited to one $250 grant per calendar year for each cystic fibrosis patient based on available funding.

Fight CF Foundation Stay Fit Grants grants are only available to cystic fibrosis patients who receive care at Children's Hospital of The King's Daughters in Norfolk, VA or Naval Medical Center in Portsmouth, VA.

I hereby certify that, to the best of my knowledge, the information provided is true and accurate.
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Stay Fit Grant Application

Tell us about your CF Care Center

Tell us how we can help you stay fit!