Sponsorship — Hoosier FWD

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Are you a Hoosier Family facing financial hardships due to medical bills for children with special needs?

Name

First Name

Last Name

Requested Donation Amount

Do you have insurance?

Is it private insurance or through an employer?

Is your child on Medicaid or a Medicaid Waiver?

Subject

Purpose of donation:

What type of donation are you requesting? (braces, assistive devices, medical bill assistance, etc.)

Message

Tell us your story and why your family could benefit by a sponsorship from Hoosier FWD. Please keep in mind we are unable to make cash donations directly to families.