* Individuals who have either started the actual IVF process themselves or are about to start the IVF process based upon recommendation of their infertility doctor.
(We are defining the IVF process in this context as medications leading up to egg retrieval, blood work, sedation during retrieval, egg fertilization, embryo transferal, blood work for pregnancy testing, and ultrasounds.)
WHO DOES NOT QUALIFY
* Individuals who are currently looking for funding to support initial fertility testing, Clomid usage, or Intrauterine Insemination (IUI) are ineligible.
* Individuals who have already been through at least one or more IVF processes and are looking for scholarship funds to cover current accumulated debts do not qualify. However, if you are starting a new cycle (e.g., ran out of embryos and need to harvest additional eggs, etc.) you can apply for a scholarship to cover those new expenses.
* Individuals who may be purchasing sperm, eggs, embryos, or costs associated with embryo adoption do not qualify.
* Scholarships will very in value between a minimum of $2,500 and a maximum of $25,000 depending on the recipients situation.
GRANT APPLICATION RULES
AUTHORIZATION TO DISCLOSE HEALTH INFORMATION
As part of the application process you will need to download our Authorization to Disclose Health Information form from within the application. That form will need to be signed and forwarded to your physician. Your physician will in turn need to send an email to email@example.com explaining your infertility diagnosis and whether your doctor believes that you are a good candidate for IVF procedures.
The verbiage in the agreement can be found below:
The specific health information authorized for disclosure is information about my infertility diagnosis and my prognosis with In Vitro Fertilization (“IVF”) procedures.
The purpose of the disclosure is to provide information to Legends are Born Everyday Foundation (the “Foundation”) as part of an application for a grant to help cover the costs of IVF procedures.
This authorization will expire on the following date, event, or condition: .
I understand that if I do not provide an expiration or condition, this authorization is only valid for the period of time needed to fulfill its purpose. I also understand that I may revoke this authorization at any time, by sending written notification to the doctor or medical provider indicated above.
I understand that the information used or disclosed under this Authorization Form may be subject to re-disclosure by the person or facility receiving it and may no longer be protected by federal or state privacy regulations.
By signing, I acknowledge that I have been provided a copy of this signed authorization. Patient Name/Date
* SELECTION. If you are chosen you will hear from the Foundation via email. Please make sure that your email address is entered into the application correctly. If you are not selected you will not receive any messages beyond the automatic confirmation of your application submission after the survey's final page.