This form is the post-donation Donor Grants application. This is for financial assistance for living kidney donors that have donated within the last 6 months in Indiana. There is a maximum cap of $200. Funds should be used for expenses related to donation including, but not limited to home utilities, childcare or grocery bills. Funds are limited. 

Information on the 2017 Donor Appreciation Network Scholarship for living kidney donor educational expenses coming soon!

Name *
Name
Explanation of Funds Needed
Phone
Phone
Address *
Address
Social Worker Phone
Social Worker Phone
Social Worker Name
Social Worker Name
Checkbox *