Individual Grant Application

This grant application is to be completed by a nonprofit organization providing services to this specific patient. If this application is approved by the Board of Directors, the funds will be released to the provider so that they can be distributed to the patient.

 Directions: Click the button below and print it to complete the application. Be sure all fields are filled in and necessary signature fields are completed on the form.

Once completed, email directly to joy@bcfundofohio.org.

ALL FIELDS ARE REQUIRED.