Grant Fund Application

We are sorry that you’re here. Whether you’ve just found out that you are unlikely to be able to have biological children or you’ve recently lost a child, we know that navigating this new normal can feel impossible and overwhelming. We hope that our grant can be a very small source of relief for you as you press forward in your grief.

Please fill out the application below and someone from our team will be in touch if any additional information is needed. If you have any questions, you can reach out to Brittany Facinoli, our co-founder, at brittany.facinoli@gmail.com.

Step 1 of 2

Your Personal Information

Your Name(Required)

First Last

Spouse's Name

If applicable

First Last

Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Out of the Ashes 5k – Grant Fund

Share your story

Please tell us, in as much or little detail as you feel comfortable, a little bit more about your story. Help us get to know your family and your journey.

Type of Grant You're Applying For(Required)

Please select the grant you're applying for. Your application must include a bill from the last 12 months (paid or unpaid) from a healthcare facility with a clear description of services.

Home miscarriage – Up to $250

Miscarraige + D&C – Up to $2,000

Labor & Delivery – Up to $4,000

Infant Emergency + NICU Expenses – Up to $5,000

Fertility Consultation – Up to $500

Infertility Discovery Tests - Up to $1,000

Other

Are you insured?(Required)

Name of Sharing Service & Member Number(Required)

Please list any information about coverage of this sharing service

Insurance Company(Required)

Name of Insured(Required)

Group Number(Required)

Documentation(Required)

Upload Your Bills, Receipts and Supporting Documents. Please note: We require an official bill that shows what you owe after insurance — if you are insured. Because we pay directly to the healthcare facility in your place, we need an official bill. It will need to show your full name, mailing address, where your services took place, type of service, a due date for the bill, and how to pay. If you have not yet received an official bill or if your balance is still pending insurance, please return to this application once your bill is finalized.

Drop files here or

Accepted file types: pdf, png, jpeg, Max. file size: 200 MB.

Grant Fund Application

Your Personal Information

Out of the Ashes 5k – Grant Fund

Grant Program