Fertility Answers - Helping Build Families

Gift of Hope Application Instructions

To be considered for the GIFT of HOPE treatment grant award, all applicants must provide the following information.

Incomplete applications will not be considered.

  • A fully completed and signed application form.
  • If you are NOT a patient of Fertility Answers (within the last two years), you will need to provide a signed letter of referral (on letterhead) from your gynecological professional providing a diagnosis and medical need for IVF treatment, plus copies of any pertinent medical records or lab results. Without this information, the committee cannot fully evaluate your need for in vitro fertilization or your chances of success with this treatment.
  • Proof of income/wages. Please provide a copy of IRS form 1040, 1040A, 1040ES or 1040EZ – US Individual Income Tax Return of your 2021 Federal Income tax return (both returns if partners file separately). Please do not send original documents. Failure to provide sufficient income documentation will disqualify your application. If you and/or your partner are self-employed, please include a letter describing your business, incorporation status and other details pertinent to your financial status.
  • Copy of medical insurance cards (front and back) for both applicant and partner.
  • A personal letter, statement or other documentation to the committee explaining the compelling nature of the applicant’s circumstances, struggles with infertility and why you feel you are a candidate for the award. Any video submissions must be less than 5 minutes/50MB in length.
  • A signed media release giving the Gift of Hope full rights to tell the applicant’s story.
  • Application must be received on or before Friday, April 29, 2022. Any application received past this date will not be considered.
  • If you require any materials to be returned, please indicate this when sending in your application as all applications and accompanying materials are destroyed after award selection. Original application and accompanying materials that you desire returned to you can be picked up from our Lafayette office after May 31, 2022.