Apply for Grant

Alliance in Reconstructive Surgery (AiRS) Foundation Policy for grants to individuals

All grant applications for medical expenses relating to breast reconstructive surgery submitted through this process will be considered.

Each applicant who has undergone a mastectomy will be considered for a grant, based on their application details and the support information received. All grants are awarded through an objective and nondiscriminatory selection process.

Criteria for AiRS Foundation’s grants to individuals are based on the Foundations submission to the IRS at the time of its approval for 501(c)3 standing as a charitable foundation. Grants awarded may range from an individual’s medical bill co-pay to the full cost of reconstructive surgery, hospitalization, and other related medical expenses.

An individual may be disqualified based on IRS Code Section 4958 or a grant may be revoked if it is determined that information has been falsified.

BREAST RECONSTRUCTION PROGRAM

Dear Breast Cancer Survivor:

We understand that you wish to be considered as a candidate to receive charitable benefits through the Alliance in Reconstruction Surgery Foundation (AiRS) breast reconstruction program.  This grant application and client agreement, when signed by you, confirms your agreement with the terms of participation in the program.

Application and Client Agreement Forms

Included in this downloadable document you will find the grant application packet, including client agreement, AiRS News & Publication Authorization Form, Policy and Statement of Need.

The mission of AiRS is to Advocate, Educate, and Support women who wish to have restorative breast surgery to help restore self esteem and feel whole again.  We look forward to receiving your complete & thorough application so we may help you as quickly as possible.

Thanks to the generous support from donors, we are able to award full and partial grants to qualified applicants.  Per the Candidate Criteria on page X. Applicants above the Federal Poverty Guidelines who demonstrate and document financial hardship and need may be considered for a partial grant award.

The application consists of the following sections:

  • Welcome letter, Application Checklist, and client agreement
  • Grant application
  • News & Publication Form
  • Policy for Grantee
  • Statement of Need
  • Supporting Documentation per Application Checklist

Please carefully read the application instructions.  Your application must be complete and legibly PRINTED or typed (no cursive please), and will not be considered until all sections are submitted together. AiRS will close incomplete applications after 30 days unless an extension is approved.

We carefully review each grant application in the order received. Unfortunately, we cannot tell you if you qualify prior to receiving your complete application.  Processing and approval of complete applications may take between 14-30 days. Please allow 30-60 days prior to surgery for approval. All requests must be pre-approved.

If your grant request is approved, the grant award will be paid directly to medical providers/facilities to pay for breast reconstruction and related medical expenses.  AiRS will not reimburse patients for past breast reconstruction or related medical expenses. AiRS’ mission of helping women with breast reconstruction prevents us from helping to pay for living expenses or transportation.

The following checklist is provided to assist you with ensuring a complete application.  Upon receipt of your completed grant application package by email or mail, applicants will be assigned a patient advocate who will reach out to you via your preferred method of contact. If you have questions regarding the application prior to submission, please email info@airsfoundation.org.

You may return your application by mail or email only.  Please email in one PDF document and please do not take photos of individual pages.  If you do not have access to a scanner, your surgeon’s office may be willing to email it for you, or you may visit a local library, Kinkos printing business, or mail to the address on the application.

We look forward to receiving your application packet.

Sincerely,
AiRS Team

Email: director@airsfoundation.org
Mailing Address: Attn: Director AiRS Foundation, 3401 Lee Parkway, Suite 1504, Dallas, TX 75219

FEDERAL POVERTY GUIDELINES
2018 FEDERAL POVERTY GUIDELINES
You must meet the Federal Poverty Guidelines in order to be considered for the Alliance in Reconstructive Surgery’s services:

Poverty-Guidelines-Table-2018