Apply

In order to apply for a housing reimbursement grant, please see the requirements below, and fill out your information to submit an application.

  • Families must have children with a congenital heart defect and/or who are awaiting a heart transplant who are actively receiving care in the hospital
  • Families who are out of state and receiving outpatient care in the hospital are also welcome to apply
  • Contact information for a Social Worker from the hospital where your child is receiving care is required
  • Social Worker must be able to validate that your child was receiving care during the time you are requesting housing reimbursement for
  • An invoice of the monthly housing expense(s) you are requesting reimbursement for must be provided at the time of application
  • Families are welcome to apply more than once, but will only be selected for housing reimbursement once per calendar year
  • Families that have been selected for reimbursement each month will be notified after the application period for the month has ended
  • Applications must be received by the last day of the month to be considered for that month (Ex: To get reimbursed for November housing expenses, applications should be submit any time from November 1-30)
Applicant Information
















Patient Information
Patient First Name:

Patient Last Name:

Patient Age:

Diagnosis:

Reason Housing Reimbursement Requested:

Current Treatment Information
Social Worker Name:

Social Worker Email:

Social Worker Phone:

Hospital Where Receiving Care:

Is the hospital 50+ miles from home?:
This is just for informational purposes only and will not impact your eligibility.


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