Get Support · Scholarships

Scholarship Application

Financial assistance for families facing a complicated pregnancy, a difficult delivery, or the loss of a baby. A parent, friend, family member, or nurse may apply on a family's behalf.

Applicant information

Your contact details so we can reach you about this request.

Full name *

Email address *

Phone number *

Mailing address

I am applying as *

The family being helped

If you're applying for someone else, tell us about them. If this scholarship is for you, write "same as above."

Family / recipient name

Hospital or clinic

City & state

Due date or date of loss

Your situation

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

What kind of support are you seeking? *

Financial scholarship Care / grief basket Resources / referrals

Briefly describe your circumstances *

Amount of assistance requested

How soon is help needed?

What would the funds go toward?

A few last things

How did you hear about us?

Referred by (name, if any)

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 apply 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 application and reaches out personally. There is no cost to apply, and every request is handled with compassion and confidentiality.