SCID Angels FAMILY Scholarship - SCID Angels For Life Foundation

SCID Angels for Life is happy to offer SCID Family Scholarships to affected families in the US who are currently going through treatment for Severe Combined Immune Deficiency. We understand the financial burden that is being placed on families when they’re given the diagnosis of SCID. Often it means abruptly having to take a leave of absence from work so you can care for your SCID child. For families with other children, they’re often asked to separate the siblings in an effort to keep the SCID child isolated and protected. Not only is this a financial hardship but it also takes an incredible emotional toll on the family unit.

In an effort to try and lessen the financial pressures SCID families often feel, we’ve developed this scholarship program. Scholarships of up to $1,000 are available to approved families. This money, for example, can be used to pay for travel back and forth to the hospital, pay for childcare for siblings, or even help pay utility bills that may be building up back at home, whatever it is you need. Now because of newborn screening for SCID in all 50 states, we’re receiving a high volume of requests. Please submit one request per family and keep in mind it may take four to six weeks for your application to be approved. Approved scholarships will be funded directly to a Venmo or PayPal account which must be in the applicant’s name. If you do not already have a Venmo or PayPal account, apply for a free account BEFORE submitting your application.

For the year 2023, Chiesi Global Rare Diseases will match any donation to the SCID Angels Family Scholarship Program up to a total of $20,000.

SCID Family Scholarship Application

First Name:
Last Name:
Email Address:
Home Street Address:
Home City:
Home State:
Home Zip Code:
Is this also your mailing address?:	Yes No
If no, please provide your mailing address:
Home Phone Number:
Mobile Phone Number:
Other Contact Phone Number (specify location: e.g., hospital room, family member's home, etc.):
I prefer to be contacted for follow up questions by:	Email Home Phone Mobile Phone Work Phone Fax Other Phone Listed Above
Approved scholarships will be funded via Paypal or Venmo. Please indicate which service you use and provide the username or account name. The account must be in the applicant’s name. If you do not have an account, you will need to open a free account before we can process your scholarship.
If approved, my scholarship should be sent via:	PayPal Venmo
What is the username or account name associated with the PayPal or Venmo account:
What is the phone number associated with the PayPal or Venmo account:
Your SCID Angels Family Scholarship Fund Request:
Are you the parent of a child with a SCID diagnosis?:	Yes No
Is this your first request for financial assistance from SCID Angels?:	Yes No
Child's first and last name:
Amount of Request (Not to exceed $1,000):
Do you need assistance with any of the following:	Child Care For Sibling Food/Nutrition Medical Expenses Rent Assistance Utilities Medical Equipment Other
If you selected "Other", please specify:
Describe the need and use of funds (please describe what the funds are to be used for, reason needed, and how this will improve the quality of life for your SCID affected child in the box provided):
SCID Angels for Life has limited scholarships available and cannot fund all requests. Tell us what makes you the ideal candidate for this funding?:
Other Funding Sources:
Is your child currently covered by private insurance?:	Yes No Uncertain
Does your child have Medicaid/SSI?:	Yes No No, but we are applying Unsure
Diagnosis Details
Was your child identified through newborn screening?	Yes No
If picked up through newborn screening, in what state?
Has the diagnosis of SCID been confirmed?	Yes No
At what age was your child diagnosed?
What is your child's form of SCID? (example, X-Linked, ADA, Jak3, unknown, etc.)
What treatment has your child had or what is planned, such as BMT, ERT or Gene Therapy? Please be specific.
Do you have more than one child diagnosed with SCID?	Yes No Another child is being tested
Is your child currently hospitalized?	Yes No At home in isolation, but awaiting treatment in the hospital
At what hospital is your child currently being treated?
Are you working with a Social Worker	Yes No
If you are working with a Social Worker, may we contact him or her?	Yes No
If we may contact your Social Worker, please provide his or her name and contact information.
Who is your child's Immunologist? If you are not being seen by an immunologist, who is your treating physician and what is their area of specialty (e.g., Hematologist/Oncologist, Pediatrician, General Practitioner)?
Is there additional information you would like us to know?
By checking the box below, I understand all information will be used for Scholarship Evaluation and I affirm all information provided is accurate to the best of my knowledge.	I agree
By checking the below box, I understand that if provided a scholarship, I will be responsible for any applicable state or federal taxes which may apply.	I agree
Applications are reviewed monthly by our Scholarship Committee. Due to a high number of requests, expect at least 4 weeks before you will receive a response from SCID Angels for Life regarding your application.	I understand it could be up to 4 weeks before I receive a response.
At this time, SCID Angels can only award Family Scholarship requests to first time applicants.

The SCID Angels Family Scholarship Program is supported by: