Request for Financial Assistance Application

OUR MISSION

For the Children, Inc. is a non-profit organization whose mission is to provide financial assistance to families with children in need of medical treatment outside their community.  We do not provide funding for medical treatment; rather we provide financial assistance for travel expenses to the treatment facilities.

All funding comes from private donations.  We strive to make sure our donations are utilized effectively and appropriately.  We appreciate your understanding as you fill out the application.

WHO CAN APPLY

To be eligible for funding, you and your child must meet the following requirements:

  • Child is 18 years old or younger.
  • Family resides in Montana.
  • Child custody is parent(s) or the legal guardian(s).
  • Treatment outside the area must be prescribed by a licensed physician. (Verification from your doctor may be requested.)
  • No other financial resources are available for family. (Proof of family income may be requested.)
  • Total household income not to exceed income guidelines using Healthy Montana Kids Income Chart.  Please refer to table below:

Household Size
(Children and Adults)

Annual Gross Household Income

Family of 2

$38,775

Family of 3

$48,825

Family of 4

$58,875

Family of 5

$68,925

Family of 6

$78,975

Family of 7

$89,025

Family of 8

$99,075

 

 APPLICATION DIRECTIONS

Please fill out the application and consent form.  If applying online, your application will be received immediately after you submit.  If you prefer by mail, print application and mail the form to:  For the Children, Inc.  P.O. Box 21, Whitefish, MT 59937.  Please note that all areas must be filled out in order to be reviewed.

Your application will be reviewed by a committee.  You should receive a response by mail within 30 days of applying.

We provide financial assistance on a reimbursement-basis based on receipts from your travel to your child’s medical treatment facility.  If you are approved, you must provide us receipts for your travel expenses in order to be compensated.  The dates on these receipts must match the days your child was in treatment.  We compensate up to $5,000 per child within his/her lifetime.

PLEASE NOTE:

  • We DO NOT pay for medical expenses.  Travel expenses only which is limited to transportation, lodging, and meals.
  • If your child is on Medicaid or HMK, we will only compensate for those expenses beyond what Medicaid or HMK will reimburse. Please do not request reimbursement for expenses covered under Medicaid or HMK.  Failure to comply with this will result in a loss of current financial assistance and denial of future applications.
  • For the Children, Inc. has the right to refuse financial assistance at anytime.

 PROCESS

After your application is approved, you will be responsible for providing necessary documentation to obtain reimbursement for travel expenses for your child’s travel to a treatment facility.  You will need to submit the following after your travel:

  1. A copy of all receipts and the total expenses for one adult and one child you are requesting for reimbursement.  Bank and/or credit card statements will not be accepted.
  2. Financial assistance is based on standards guidelines that coincide with national per diem rates.  In providing estimates for travel, please note the following:
    • Transportation is based on car mileage to treatment city regardless of form of travel.
    • Lodging is based on average rates for the treatment city.  However, we are aware of many hotels that provide deep discounts for those seeking medical treatment.  We will request that you stay at one of these locations.  If you decide not to stay at a discounted location, we will only pay the rate of discounted location.
    • Meals are based on a per diem rate.  We provide financial assistance only for one adult and the child who is in need of medical care.  Chidren ages 12 and under will receive half the adult per diem rate.
  3. Please note that the following items will not be reimbursed:
    • Alcohol or Tobacco products.
    • Junk Food – potato chips (including Doritos, Cheetos, etc.), candy, chocolate, liters of soda, high energy drinks, etc.  A soft drink from a restaurant is acceptable.
    • Toiletries, diapers, and other incidentals.
  4. Travel Reimbursement Form – if your application is approved, you will receive this form. After your travel, fill out the form and attach all receipts to the back. Be sure to sign the form to verify that travel occurred for medical treatment reasons and that you did not receive other funding for these expenses. You will be expected to deduct any costs that are not approved for reimbursement. Failure to turn in receipts will result in loss of current financial assistance as well as any future requests.
  5. Mail form and receipts to: For the Children, Inc. P.O. Box 21, Whitefish, MT 59937. You should receive reimbursement within 30 days of mailing.

For more information or help with the application process, please contact us at (406) 862-8146.