Financial Assistance Program

The NHF Idaho Chapter's Financial Assistance Program (FAP) is part of our continuing effort to improve quality of life of individuals and families affected by bleeding disorders. The purpose of the Financial Assistance Program (FAP) is to provide financial support to members of our community in our continuing effort to improve the quality of life of our community. NHF Idaho provides financial support, based on availability of funding, ,to help defray the costs of:

  • Expenses incurred in the care, treatment, or prevention of a bleeding disorder;
  • Funeral expenses
  • Health Insurance Premiums
  • Emergency transportation services to HTC's Basic living expenses emergencies; and
  • Other related expenses determined to be appropriate by the NHF Idaho  (rent, mortgage, utilities, etc.)

ELIGIBILITY

Applicants for financial assistance will need to meet the following criteria

  • Be a resident of Idaho and/or receive treatment from the local Hemophilia Treatment Center (HTC). Residents outside of Idaho will not be eligible and should contact their local chapter for assistance.
  • Be a parent or caregiver of a minor child who lives in your home and who has a diagnosis of a bleeding disorder OR be an individual diagnosed with a bleeding disorder.
  • Complete the Financial Assistance Application and meet the financial need requirements of the Financial Assistance Program policy
  • The Idaho Chapter of NHF recommends requesting assistance from at least two (2) other agencies before applying to the Idaho Chapter of NHF for funding. Please provide any relevant contact information for those agencies and the status of your request.

Applicants should allow at least 14 business days for NHF Idaho to process their request.


Assistance is limited to one grant per calendar year, per household, with a maximum of $500 being available for financial assistance. 

NHF Idaho cannot provide funding directly to the individual applicant(s).  Disbursements will be made directly to vendors identified in the application that have been verified by NHF Idaho.

The Executive director will notify the applicant about the decision within two business days of the committee meeting via email or phone communications. In most cases, approval applicants can expect a total of two-three weeks for the entire process and payment to be submitted.

Please submit all applications along with relevant bills and other relevant supporting documentation via email or postal mail (no fax available) to bfawcett@hemophilia.org

OR

Idaho Chapter of the National Hemophilia Foundation

4969 W Overland Rd suite 234                                                                                                                                                                                                         Boise Idaho 82705

APPLICANT INFORMATION
I have read and understand the Financial Assistnace Program guidelines & policy
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
FINANCIAL ASSISTANCE REQUEST
Are you or your family, patient(s) of St. Lukes HTC?
Are you or a family member affected with a bleeding disorder?
If Yes, Please explain type of bleeding disorder
Have you or a family member had any hospitalizations or surgeries in the past year?
If Yes, Please explain
Does the applicant have mobility issues, chronic pain or joint replacement issues as a result of a bleeding disorder?
If Yes, Please explain
Does the applicant have any other medical conditions besides a bleeding disorder?
If Yes, Please explain
Have you applied to other financial assistnace programs for your current need?
If Yes, Please explain
Have you or your family applied to NHF Idaho's financial assistance program in the past 3 calendar years?
If Yes, Please explain
Have you or your family attended NHF Idaho's programs or events such as Camp Red Sunrise, Educational Weekend, Idaho Hemophilia Walk, or Blood, Sweat & Cheers Golf Tournament?
If No, Please explain
Describe any past or current involvement and/or participation in the bleeding disorders community, to include but not limited to participation in events, volunterring, financial or other contributions to the community.
Describe in detail how assistance will help resolve your current need.
In your opinion, is this a one-time or recurring financial need?
NHF Idaho is able to provide a mazimum of $500 funding per household per year. When are the funds nedded?
NHF Idaho cannot provide funding directly to individuals. However, if approved, NHF Idaho will pay directly to a vendor. Please list your bill payment information below and upload copies of bills below with contact information wherever possible.
BILL PAYMENT REQUEST INFORMATION
Country
Address Line 1
City
State
Postal Code
I certify that the information I have submitted is true and accurate to the best of my knowledge.
CONFIDENTIALITY

Applicant names and information pertaining to funding request are considered confidential to the full extent permitted by law.

Information from the NHF Idaho financial Assistance program application maybe be compiled for statistical purposes and for compliance with local, state, federal or affiliated organization requirements. However, any publication of this data will be aggregate form only and will not include names or any other information that could be used to identify individual applicants or recipients.

No personal information will be used or disclosed for any purpose other than that for which it was collected without the applicant’s written permission. At no time will personal information be shared with any individual, company and/or organization outside the Idaho Chapter of the National Hemophilia Foundation.