817-653-8976 info@project4031.org

Funding for Families Application

Project 4031 provides funding assistance for basic needs for terminally ill children and adults with a current life expectancy of six months or less. We are a small nonprofit located in Fort Worth, TX and primarily serve patients living in Texas, with a concentration in the DFW area. We do our very best and make every effort to provide help for families struggling financially that are unable to make ends meet on their own.

Funding for Families Application

This application can be submitted by the patient, family, friends or medical professional. If the applicant is under hospice care, please have a hospice representative complete a hospice application.

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Who is eligible to apply?
Terminally ill children and adults with a life expectancy of six months or less are eligible for funding to help with basic needs. Before applying please take a full assessment of the financial situation and be prepared to provide all required information requested on the application. It is not relevant if a patient/family has received resources from other agencies. Although we request this information be provided, it will not affect their application.

Application Instructions: *IMPORTANT* No pictures of applications will be accepted.
Completed applications can be faxed to (817) 841-8250, scanned and emailed to info@project4031.org, mailed or delivered in person to 708 May St, Fort Worth, TX 76104. We receive many requests and review each one as quickly as possible, with a goal to contact you within two business days of receiving the completed application. We know time is of the essence, so please help ensure a smooth application process by submitting all required information in a timely manner. Please read through the application carefully and fill it out in its entirety before submitting. Current copies of bills/statements must be provided with an application for it to be complete. Applicants must present clear copies of the entire document, showing an up to date amount owed so we have an accurate picture of how much assistance is requested. If you are not sure, if your application is complete, please call us at (817) 653-8976. If we receive an incomplete application, it will not be processed until all required information is received. Depending on the Funding request, Project 4031 may require additional information.

We cannot fulfill the following types of Funding requests:

  • Medical treatments/procedures
  • Medical/hospital bills
  • Health insurance
  • Prescription medications
  • Taxes
  • Credit card bills
  • Cable/internet bills

Project 4031 must have the following documents to process a Funding request. Please attach them to the application before submitting:

  • Documentation with letterhead from treating physician showing proof of care/service of Patient
  • Proof of income (paycheck stub, letter from employer, Social Security check stub, etc.)
  • Current copies of all bills/statements that you need
  • Funding assistance with
  • Signed Medical/Media Release
  • Signed HIPAA Form
  • Signed Waiver and Release of Liability Form

Partnerships

Contact Us

708 May Street, Fort Worth, Texas, 76104
info[at]project4031.org
Phone: (817) 653-8976
Fax: (817) 841-8250