info@jakeshelpfromheaven.org

Jake’s Help from Heaven Repeat General Application

Jake’s Help from Heaven, founded in 2011, is a non-profit that creates opportunities for those with complex medical challenges and physical disabilities to thrive.

 

Effective as of June 19, 2024, Jake’s Help from Heaven has adjusted our mission and made some policy changes to ensure the sustainability of our organization.  Please review our new standards carefully.  We are committed to continuing to make a difference in the lives of those who need us for as long as we can, while also staying true to our roots.

Grant Eligibility: 

  • Grants are limited to individuals living within 40 miles of Saratoga Springs, New York.
  • Grants are restricted to individuals of any age with complex medical needs and physical disabilities resulting from congenital or childhood-onset
  • There is a $1,500 cap per applicant per calendar year.
  • Priority is given to repeat applicants.

INCOMPLETE APPLICATIONS WILL NOT BE SUBMITTED TO THE BOARD OF DIRECTORS FOR CONSIDERATION. THE FOLLOWING CRITERIA MUST BE MET:

  • A post-appointment letter or complete discharge notes from the treating doctor indicating reason(s) for treatment and the treatment dates.
  • Completed Expense Worksheet with all columns totaled.
  • Completion of the following application with the signature of a pediatrician/primary care doctor, social worker, or care worker.
  • Receipts for reimbursement.
  • To be eligible for reimbursement, the travel must have taken place within one year of the date that the application is being reviewed.
  • Applicants should submit their completed applications with all required documents at one time, and not in separate pieces.
  • Electronic applications must be submitted in PDF format. We DO NOT accept jpegs or screenshots.
  • If you receive your requested funds elsewhere, please alert us immediately so that we can withdraw your application. Failure to do so may affect your eligibility to apply in the future. 
  • Please double-check that the applicant’s address is listed correctly. JHFH is not responsible for replacing reimbursements mailed to the wrong address due to errors on the application.
  • When individuals other than the applicant are completing the application, please write in the third person and do not write in the applicant’s voice.

Grant Eligibility: 

  • Grants are limited to individuals living within 100 miles of Saratoga Springs, New York.
  • Grants are restricted to individuals with complex medical needs and disabilities resulting from congenital or childhood-onset diseases. Applicants of all ages with lifelong, debilitating illnesses are welcome to apply.
  • This application can only be used for general requests by individuals who have previously applied, have not reached the $1,500 calendar year cap, and have not had a change in diagnosis.
  • Repeat applicants are for GENERAL requests only. Repeat travel and technology requests must still be made through the Travel or Technology Applications.

AS OF 2024, INCOMPLETE APPLICATIONS WILL NOT BE SUBMITTED TO THE BOARD OF DIRECTORS FOR CONSIDERATION. THE FOLLOWING CRITERIA MUST BE MET:

  • Completion of the following application with the signature of a pediatrician/primary care doctor or social worker.
  • A doctor’s prescription and/or a professional letter of medical necessity by a doctor, therapist, or teacher. The letters of medical necessity must be signed and dated, preferably on letterhead.
  • Proof of payment is required for reimbursement or vendor information for direct purchase. We do not award money for general donations or support.
  • To be eligible for reimbursement, items and services must have been purchased within one year of the date the application is being reviewed.
  • Applicants should submit their completed applications with all required documents at one time, and not in separate pieces.
  • Electronic applications must be submitted in PDF format. We DO NOT accept jpegs or screenshots.
  • There is a $1,500 cap per applicant per calendar year. Applicants may apply multiple times within a calendar year but are only eligible to be awarded a total of $1,500 within that year.  
  • If you receive your requested item elsewhere, please alert us immediately so that we can withdraw your application. Failure to do so may affect your eligibility to apply in the future. 

IN ADDITION, PLEASE NOTE THE FOLLOWING POLICY CHANGES:

  • Effective May 20, 2024: the yearly grant limit is now $1,500.
  • If the primary letter of medical necessity was written by the individual or practice providing the requested service, we require a second letter or script from a disinterested medical provider.
  • Please be precise when providing product information. JHFH is not responsible for returning/exchanging incorrect items that resulted from a mistaken request.
  • Please double-check that the applicant’s address is listed correctly. JHFH is not responsible for replacing items mailed to the wrong address due to errors on the application.
  • Applicants requesting a grant of over $1,000 may be asked to submit a current income tax return or other financial information.
  • When individuals other than the applicant are completing the application, please write in the third person and do not write in the applicant’s voice.

Jake’s Help From Heaven Repeat Applicant Program 2024

Applicant:(Required)
Parent/Guardian’s Name:(Required)
Address(Required)
Contact information for the individual completing the application (if different from applicant/guardian):
Name
MM slash DD slash YYYY
Was it approved?(Required)

Section B: Application Details

Which type of payment are you seeking? Check one

A doctor's prescription and/or letter of medical necessity is REQUIRED. You may upload your documents here or mail your documents in.

Drop files here or
Accepted file types: jpg, pdf, Max. file size: 768 MB.

    Receipts of purchased items OR vendor information for item to be paid directly by Jake's Help from Heaven is REQUIRED. You may upload your documents here or mail your documents in.

    Drop files here or
    Accepted file types: jpg, pdf, Max. file size: 768 MB.

      Section C: Disclosure/Signature

      I declare that the information provided on this application for financial assistance is true and complete to the best of my knowledge. I understand that what I submit to Jake’s Help from Heaven is for the purpose of financial reimbursement or direct purchase of medically necessary or convenient items and services. I understand that I may be required to provide additional evidence of submitted information, including a current income tax return or other financial information. I give permission to Jake’s Help from Heaven to contact the provided medical facility for verification purposes. I agree to allow Jake’s Help from Heaven to use my name in announcements and related publications.

      Parent’s name printed(Required)
      MM slash DD slash YYYY
      Primary Doctor or social worker(Required)

      You may upload a photo or a scan of a signed document from your doctor with the endorsement saying "I (social worker or primary doctor) support (applicants name) application for (requested item) on (date)” or use the save and continue option and send your social worker or primary doctor the link for them to sign. After adding their signature, your doctor or social worker must then use the save and continue option and send you the new link to your form.

      Max. file size: 768 MB.
      MM slash DD slash YYYY
      This field is for validation purposes and should be left unchanged.