Grant Requirement
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 THE REQUIREMENT fOR APPLICATION TO BE PROCESSED INCLUDE;

 

1.     Submit Application form

Application form can be downloaded from the website or picked from our office. Only completed forms are considered. 

Click to download the Grant Application Form

   

    2.     Application Justification

A written description of your fertility history stating why you are applying for financial grant and the reason your case should get priority attention. Note: the section for application justification is included in the Grant Application Form.

 

    3.     A Medical Report

Every applicant for financial grant must attach a medical report from JOJE ABEBE Fertility Center containing a summary of the applicant’s medical history, fertility evaluation and treatment plan. Also the report should contain the estimated total cost of treatment

 

    4.     Authorization Form

Applicant is also required to fill out and sign Patient Authorization Form for Use and Disclosure of Protected Health Information.

  Click to download the Authorization Form

 

    5.     Signed Media Release Form

A release form will be required to be filled by the applicant, thus granting JOJE ABEBE ART Foundation the right to use excerpts from your personal statement and pictures to inspire and motivate others being confronted by the burden of infertility.

Click to download the Release Form

 

    6.     Informed Consent

Applicant is also required to sign an informed consent before submitting His or Her application.

Completed forms with all requirements should be mailed to the following address: JOJE ABEBE ART FOUNDATION, P.O. Box 18549, Area 10, Garki, Abuja or Submitted to the Office.



 

Our Address:

A33 Copa Cabana Homes,
Wumba District, Off Apo/Lokogoma, Abuja.

Contact Us

09081699998 

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