Blakelyn Foundation Grant Application

The Blakelyn Foundation is a non-profit 501(c)3. We are dedicated to helping families with medical and funeral expenses for infants loss during pregnancy, at birth, or shortly thereafter up until one year of age. We know the pain of receiving medical bills in the mail after losing an infant. We are available to assist with up to $1,000 towards these expenses, regardless of your financial status. Our goal is to help alleviate that financial burden and allow families time to grieve.

Requirements to receive assistance are as follows:

• We only assist with funeral and/or medical expenses pertaining to infant loss during pregnancy, at birth or shortly thereafter up to one year of age.

• We assist with medical expenses and any funeral expenses including cremation, casket, burial and headstones.

• You must submit the grant application along with a copy of medical bill and/or funeral home invoice with account number, phone number and address.

• Funds will only be distributed to the provider such as the hospital or funeral home. We can not give funds to family members. The balance must be a current balance as we are not able to reimburse for previously paid expenses.

• Anyone receiving assistance must reside within the United States, must have received medical care within the United States, or must have services performed within the United States.

• The amount of financial assistance we provide does not exceed $1,000.