Application For Help With Travel Costs For Surgery

So sorry, we are not taking applications for Financial Assistance at this time due to lack of funding.

If you or a loved one is scheduled for reconstructive ear surgery (Medpor or Rib Graft) and need help with travel costs (hotel stay or airfare), please submit the following information to Ear Community for consideration:

*  All information that is required below must be complete in order to be considered for the application process.

1.  Submit a letter (four to five paragraphs in length) about the child or adult (applicant) in need explaining why help is needed with travel costs for surgery.
2.  Please include the applicant’s mailing address, phone number, and e-mail address at the bottom of your letter.
3.  Please include a picture of the applicant.
4.  Please include a copy of the letter or information stating when the date of surgery is scheduled for.
5.  Please include the surgeon’s full name and contact information (mailing address, phone number, and e-mail address) for verification of scheduled surgery date.
6.  Please include a copy of the letter from your insurance provider stating that any travel costs associated with the surgery will not be covered and have been denied, or explain if you are fundraising for the surgical procedure due to not having insurance coverage and are paying out of pocket.

Mail the above information post marked to:

Ear Community
Financial Assistance Applicant
280 E. 1st Avenue, Unit 704
Broomfield, Colorado 80038

*  You will be notified via e-mail once your application has been received.
*  While Ear Community is able to help many applicants in need, not all applicants can be selected due to the large number of applications being received.

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