DISASTER RELIEF FUND APPLICATION

To help address the challenges that occur for those affected by bleeding disorders and the organizations that serve them during an emergency or natural disasters, the Hemophilia Alliance Foundation has launched the Disaster Relief Fund.

Focus Areas:
Support to eligible non-profit entities serving individuals and their families affected by bleeding disorders who are impacted by an emergency or natural disaster for the following activities:

  • Patient Assistance / Emergency Assistance Programs
  • Operational expenses to help ensure the educational and health care support service needs of the applicant organization’s bleeding disorders community continue uninterrupted

Maximum Grant Award: Funding will not exceed $10,000 per organization

Eligibility:
Disaster Relief Grant applications are accepted from the following tax-exempt organizations:

  • State or regional organizations with a mission focused solely on serving people with bleeding disorders (i.e., National Bleeding Disorders Foundation chapters and Hemophilia Federation of America member organizations)
  • Federally funded hemophilia treatment centers serving people with bleeding disorders
  • National organizations with mission’s focused on persons with bleeding disorders. (Although the National Bleeding Disorders Foundation is not eligible for funding, its national chapters are eligible.)

Note: Applicant organizations that have an outstanding/past due report from a previously funded Hemophilia Alliance Foundation grant are not eligible to apply.

Exclusions:
Funding will not be provided for:

  • Medicine or Product donations
  • Indirect costs
  • Organizations that discriminate based on race, gender, religion, or sexual orientation
  • Requests for sponsorships or advertisements

Applications are reviewed as they are received. A response is typically provided within 5-10 business days following receipt of application.

DISASTER RELIEF GRANTS ARE SUBJECT TO THE AVAILABILITY OF FUNDS. THEREFORE, NOT ALL APPLICATIONS MAY BE APPROVED. THE HEMOPHILIA ALLIANCE FOUNDATION RESERVES THE RIGHT TO REDUCE GRANT AMOUNT REQUESTS.

Funds provided under this application may not be used for other purposes.

Form of Transmission:
Applications for a disaster relief grant will be available online on the Foundation website. Applications are to be filled out online and submitted online by pressing the SUBMIT button on the bottom of the application form. Attachments must be submitted electronically by attaching them to the application. Applicants will receive an electronic acknowledgement that their application has been received. IF YOU HAVE NOT RECEIVED AN ACKNOWLEDGEMENT OF RECEIPT, IT MEANS THAT YOUR APPLICATION MAY NOT HAVE BEEN RECEIVED. Please contact Audra@hemophiliaalliancefoundation.org if you do not receive this acknowledgement.

Final Reports:
A final report will be due 1-year following approval of the grant on the HAF website.

Questions:
For questions, or for more information about this program, please contact the Hemophilia Alliance Board Chair at chair@hemophiliaalliancefoundation.org.

Address of organization(Required)
Address to send check(Required)
Name of authorized individual completing this application(Required)
Please enter a number from 1 to 10000.
Brief narrative description of the applicant organization’s intended use of grant funds

NOTE: Applicant organization must describe the impact of the emergency/natural disaster, the need(s) that exist, and how the funding will be used to help ensure the educational and health care support service needs of the local bleeding disorders community will continue uninterrupted.

Please include or attach a budget breakdown detailing the use of emergency/disaster relief funding

NOTE: Any proposed staff salaries within the applicant's budget must not exceed 20% of the grant award and must be directly linked to addressing the response to the emergency/natural disaster.
Required Attachments
NOTE: Failure to submit attachments will result it immediate denial of the application.
  • Copy of organization’s IRS Tax Determination Letter indicating nonprofit status
  • Completed W9
  • If applying for funding that will be used for patient assistance, include a copy of your organization’s patient assistance policy.
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