Financial Assistance Program

Having a child with medical needs can add financial stress. Our mission of giving hope to little hearts also means assisting these children's families with support both spiritually and financially.

Through the generous support of The Love Adelyn Foundation's Annual Hope Fore Little Hearts Golf Scramble we are able to offer financial assistance. Annually the budget for the financial assistance program varies and is dependent on our generous supporters.

We are currently reviewing nominations for our Financial Assistance Program. If you are someone you want to nominate meet the criteria below, please apply:
1. Have a child with increased medical needs.
2. Reside in Nebraska or receiving medical care in Nebraska.
3. Have not applied for financial assistance with The Love Adelyn foundation in 2020.

Other Details:
1. All nominations will be reviewed by The Love Adelyn Foundation Board within 7-14 days of receiving the nomination.
2. All nominees will be contacted by email regarding the application - offering or declining payment.
3. Funds will be provided in the form of gift cards or direct pay for bills, no cash will be provided directly.
4. Supporting documentation may be required to further evaluate the application or process the payment.

Financial Assistance Nomination

Please input the contact information for the family that you are nominating.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Are you nominating someone else or your family? *

I am nominating someone else I am nominating my family

If you are nominating someone else please input your name and email address below.

Name *

First

Last

Email *

Tell us about the family in need *

What kind of financial assistance fits your need? *

Gas Card Assistance with a bill Assistance with needs for the family/child

Provide details on the assistance need. For example: if requesting assistance with a bill provide what type of bill and amount. *

If your family receives financial assistance can we share your story on our website and social media pages? *

Yes No Thank You I am nominating someone else

Additional Comments or Notes *

Submit