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APPLICANT INFORMATION
PERSONAL RESPONSE
WHAT ARE YOU SEEKING ASSISTANCE WITH?
ARE YOU CURRENTLY RECEIVING ASSISTANCE FROM ANYONE ELSE?Check all that apply
AUTHORIZATION

The Just Breathe Foundation ("the Foundation") is a non-profit organization committed to raising funds for persons with cystic fibrosis. The need for assistance and the number of requests received by the Foundation may exceed our resources. Consequently, neither the Foundation, its officers, directors, agents, nor employees represent that all applicants will receive funding from the Foundation. All grants are awarded on a case-by-case basis within the sole discretion of the board of directors. The application program has no exclusions as to race, ethnicity, gender, age, sexual orientation, or family characteristics.


BELOW, ATTACH DOCUMENTS THAT PROVIDE PROOF OF RESIDENCY AND DIAGNOSIS.

The Just Breathe Foundation only offers assistance to residents of Western New York.
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