Gift of Hope Application

Application Instructions for the GIFT of HOPE

Download Gift of Hope Application 2018

  • Please complete all sections of the application and provide all additional documentation as required. Incomplete applications will not be processed.
  • Proof of income/wages is required. Please provide a copy of your 2017 Federal Income tax return (both returns if partners file separately). Please do not send original documents. Failure to provide sufficient documentation of proof of income 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.
  • A copy of medical insurance cards (front and back) for both applicants (husband and wife) is required.
  • If you are not a current patient at Fertility Answers you MUST have a letter of recommendation summarizing your need for in vitro fertilization from your reproductive endocrinologist or gynecologic professional. Please have your physician include any pertinent labs and medical records so that your need for in vitro fertilization can be more fully assessed. Without this information, the committee cannot fully evaluate your need for in vitro fertilization or chances of success with this treatment.
  • Application and all required documents must be received on or before the deadline. PLEASE HAND DELIVER OR MAIL COMPLETED APPLICATION TO:
Fertility Answers
206 East Farrel Road
Lafayette, LA 70508
Attn: GIFT OF HOPE
  • After we receive your completed application you will be notified by email or mail that it has been received. Please include a current email address on your application.
  • If you have questions about the program or your eligibility, please visit our FAQ page or email your questions to: giftofhope@fertilityanswers.com.
  • Applicant will be contacted by telephone. Winning applicant and partner may be asked to be available and present for a press conference.
  • Winning applicant will be required to sign Informed Consent and Acknowledgement of Risk forms from each donating entity before in vitro fertilization cycle commences.
  • Winning applicant may be declined the award if they fail to meet pre-screening needs for in vitro fertilization. In this case, another couple may be selected to receive the GIFT of HOPE.