Financial Assistance Process old

Small  Wonders is an organization that supports Jewish couples experiencing infertility. We provide emotional support, education, and financial assistance.

Prior to beginning  the formal  application process we would like some basic information from you. This will help us in a very preliminary way to assess if and to what degree we may be of assistance to you. After reviewing the information you provided to us we will contact you and if appropriate  will initiate the formal application process.

* Small Wonders does not provide funding for any third party reproductive procedures.

Please keep a copy of your application by copying and pasting it onto a word document.

Financial Assistance

  • Husband's Information

  • Wife's Information

  • Couple's Information

  • Before submitting the application, please read the Consent Form and sign, indicating that you agree to its terms.

    CONSENT FORM - AUTHORIZATION AND CONSENT

    By submitting this application for financial support from the Small Wonders Charitable Organization (“Small Wonders”), each of the Applicants consents to the collection, use, retention and disclosure of their personal information by Small Wonders for the purposes of administering and carrying on its programs and offering its services on the basis described below. The collection, use and retention of personal information (including personal health and financial information) and the disclosure and communication of such personal information to third parties including health care providers and medical professionals as required, is essential for Small Wonders to evaluate and assess the applications for financial support and to carry on its programs and offer its services. Any such communication of personal information to third parties would be solely to the extent necessary for the purposes described below, and Small Wonders will require any party to whom the Applicants’ personal information is so communicated to retain such information on a confidential basis. Small Wonders recognizes the confidential and sensitive nature of this personal information, and has put in place procedures to ensure that the privacy of such information is protected. For additional information pertaining to the Small Wonders privacy policy, please email inquiries to support@localhost. The applicants hereby consent to, and authorize the receipt of, and disclosure by, Small Wonders and its members, directors, officers, agents, employees and service providers of the Applicants’ respective personal information (including personal health and financial information) and to the collection, use and retention by Small Wonders of any such personal information. For the purposes set out herein, the Applicant consents to the creation by Small Wonders of a personal information file containing financial and medical records and other personal information. The Applicants authorize the disclosure and communication of such personal information to any third parties only for the purposes of (i)determining the Applicants’ eligibility for financial assistance or support from Small Wonders, including for purposes of evaluating the Applicants’ financial circumstances, medical treatment plan or program, and medical files and records. (ii) complying with legal and regulatory requirements, and (iii) administering or offering Small Wonders programs and services to, or for, the benefit of the Applicants. In this Authorization and Consent “personal information” includes any identifiable information in oral or recorded form, in any format, and includes information such as the Applicants’ names, ages, identification numbers, employment data, marital and dependant status, and information that relates to or concerns the Applicants’ health and income, assets, debts, and other financial obligations. By submitting the attached application and/or accepting any financial support from Small Wonders, each of the Applicants hereby agrees to indemnify, release, discharge and save and hold harmless Small Wonders and its related and affiliated entities, and each of their respective members, directors, officers, employees and agents, from and against any and all manner of action, causes of action, suits, debts, covenants, contracts, claims, liabilities losses, costs, expenses and demands, including legal fees and expenses, of any kind that in any way arise, in whole or in part, directly or indirectly, by reason of or arising out of the application by the Applicants for financial assistance or support from Small Wonders, the Applicants’ participation in or utilization of the programs or services of Small Wonders, and/or the receipt by the Applicants of financial assistance or other support from Small Wonders. In no event will Small wonders be responsible or liable for any damages or losses of any kind including direct, indirect, incidental, consequential or punitive damages arising out of or relating to the attached application by the Applicants for financial assistance or support from Small Wonders or the Applicants’ participation in or utilization of the programs or services of Small Wonders.

Charitable Number: 811799402