Get Support

Request Support

One form for everything we offer — a handcrafted care or grief basket, a scholarship of up to $1,500, and resources or referrals. Tell us what your family needs and we'll reach out personally. A parent, friend, family member, nurse, or social worker may fill this out on a family's behalf.

Who is filling this out

Your contact details, so we know who to reach about this request.

Your name *

Your email *

Your phone *

I am applying as *

The family

These names are how we'll address the cards we send. If this request is for you, that's perfectly fine — just fill in your own details.

Mother's name *

Mother's phone

Father's / partner's name

Father's / partner's phone

Other adult(s) living in the household

Baby's name

Baby's gender

Baby's date of birth

Baby's date of death (if applicable)

Delivery / mailing address *

Names & ages of other children in the household

Hospital or clinic

What we can help with

Ask for anything that would help — you can choose more than one, and asking never costs you anything.

Are you interested in a grief/care basket?

Are you interested in a scholarship? (maximum $1,500)

If scholarship — immediate financial need

Are there non-monetary needs we could help with at this time?

Would you like more information on grief counseling?

Your situation

Share as much or as little as you're comfortable with. There are no wrong answers.

Please describe the life situation, as specific as possible *

How soon is help needed?

A few last things

How did you hear about the Claire Foundation?

Name of referring person (if not mother or father)

Email of referring person

Anything else you'd like us to know?

Back to Get Support

Your information is sent privately to the foundation and is never shared. Please don't include Social Security or bank account numbers here — we'll request anything further directly if it's needed.

Prefer to ask another way? Email us at ourclairefoundation@gmail.com.

What happens next

We'll be in touch with care

After you submit, a member of our team reviews your request and reaches out personally. There is no cost, and every request is handled with compassion and confidentiality.