Non-Educational Financial Support

Non-Educational Financial Aid

Sierra Nevada Donor Awareness financial aid is intended to help support the needs of individuals personally affected by the transplantation process as demonstrated in the community. Please note; application submission does not guarantee financial assistance. Applications will be reviewed and additional information may be requested in order to complete the process. Applicants may be rejected at the discretion of the selection committee.

Biographical Information

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Transplant/Donor Contact Info

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Transplant Specifics

Organ or Tissue Transplanted *

Name of Transplant Facility *

Date of Transplant *

Name of Transplant Physician *

Financial Aid

Amount of Financial Assistance Requested *

Please describe your need for financial assistance. Include information regarding the transplant, and any other pertinent information for the board to consider. *

Upload Additional Pages If Necessary *

Max file size: 20MB

The information on this application is true to the best of my knowledge. Your signature below authorizes the release any and all records associated with this application, including school records.

Date *

Initials *

Required File #1 - Proof of Transplant *

Max file size: 20MB

Documentation or evidence of transplant, (if you are waiting for a transplant please provide the contact information for your Transplant Social Worker and provide permission for Sierra Nevada Donate Life representatives to speak to this individual regarding your financial needs).(doc, docx, pdf)

Required File #2 - Proof of Need *

Max file size: 20MB

Please provide evidence of financial need – Sierra Nevada Donor Awareness is mandated by law to consider financial need as a basis for financial aid to be considered by the financial aid committee. (doc, docx, pdf)

Submit

Non-Educational Financial Aid

Non-​Educational Financial Aid

Biographical Information

Transplant/Donor Contact Info

Transplant Specifics

Financial Aid

Non-Educational Financial Aid