Aeron's Foundation - Financial Aid Application

1Instructions

2Primary Contact Information

3Child's Information

4Financial Information

5Grant Request

6Additional Information

7Document Upload

8Review

How We Can Help
Aeron’s Foundation provides financial assistance for expenses that bereaved parents face in making final arrangements for their baby who has died. This is made possible due to the generosity of private donations and fundraising efforts.

If you are a bereaved parent or family member seeking assistance with funeral costs, or if you are experiencing financial hardship due to these expenses, please complete the following application. Starred fields must be filled out. Submitted applications will be reviewed and response will typically be provided within 4 weeks of submission. Please remember to include supplemental documentation, and send us an e-mail in order to ensure prompt processing of your application.

If submitting through postal mail, please send the application to:

Aeron’s Foundation
Attention: Financial Assistance
P.O. Box 56061
Sherman Oaks, CA 91413

Whenever possible, grants are paid directly to the service provider. Alternative forms of financial aid that may be considered include rent assistance, payment of credit card debt, and gift cards to large vendors (such as Target, Amazon or major grocery stores). Aeron’s Foundation will not issue checks directly to the family. Families are eligible to receive financial aid up to one year after the loss of your child. For more information please contact info@aeronsfoundation.org.
Before You Start
We recommend that you download a copy of the application form prior to beginning your online submission to ensure you have all the required information and documents.
Download Paper Application
Eligibility requirements
✓ Low income household as defined by the Department of Housing and Urban Development (income does not exceed 50% of median income in Los Angeles County):

Los Angeles County FY 2022 Low Income Limits (50%) Summary (Source: https://www.huduser.gov/portal/datasets/il.html)
Persons in Family 1 2 3 4 5 6 7 8
Annual Income Limit $41,700 $47,650 $53,600 $59,550 $64,350 $69,100 $73,850 $78,650

✓ Child must be 12 months or younger, with undetermined cause of death.
✓ Must be a resident of Los Angeles County.
✓ Case must have been submitted to the LA Medical Examiner's Office

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Financial Information
Parent 1
Parent 2
Name*
First Last
Name
First Last
Date of Birth
Date of Birth
Ethnicity*
Ethnicity
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Phone
Email Address
Email Address
Marital Status
Marital Status
Occupation
Occupation
Hours of Week at Work*
Please enter a number from 0 to 168.
Hours of Week at Work
Please enter a number from 0 to 168.
Average Monthly Income*
Average Monthly Income
Other Sources of Monthly Income (examples: social security, alimony, child support, welfare, etc.)*
Other Sources of Monthly Income (examples: social security, alimony, child support, welfare, etc.)Untitled
Combined Household Monthly Income*

Number of Dependents in Family*

Relationship to Child	Age

Any additional financial information we should be aware of?

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Grant Request
Amount requested from Aeron's Foundation (Up to $1000)*
Please enter a number less than or equal to 1000.
Certification of Financial Hardship*
I certify that I am in financial hardship and need support
Disbursement Method*
- Check (i.e. funeral home, cemetery, rent assistance, bills, credit card debt)
- Gift Card
Check: All checks are sent to the family, but are written directly to the service provider. Please remember that Aeron’s Foundation will not issue checks directly to the family. For rent assistance, please include your lease agreement or a copy of rent bill for verification. If needed, Aeron’s Foundation may contact you to request more information.
Gift Card: If you are requesting a gift card, please provide the funeral/cemetery cost information and we will honor the amount up to $1,000. Aeron’s Foundation is unable to re-issue gift cards if they are lost or stolen.
Gift Card Organization*
- Target
- Amazon
- Ralphs
Preferred Gift Card Delivery Method*
- E-Mail
- Certified Mail

Please write the name of the person or company (service provider) that the check should be issued to.*

Service Provider (Who the check will be made out to)	Contact Person (if different)	Phone Number

Recipient Name*
Recipient Address*
Street Address Address Line 2 City State ZIP Code
Recipient Email*
Please describe how this financial assistance will benefit you and your family:*

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Persons in Family	1	2	3	4	5	6	7	8
Annual Income Limit	$41,700	$47,650	$53,600	$59,550	$64,350	$69,100	$73,850	$78,650

Financial Aid Application

Financial Aid Application

How We Can Help

Before You Start

Eligibility requirements

Primary Contact Information

Child's Information

Financial Information

Parent 1

Parent 2

Grant Request

Additional Information

Document Upload

Attestation