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Ready to apply?

Fill out the form below to apply directly, or download the PDF version to complete offline and email to info@jmfworld.org.


Grant Application Form

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Are you a member of the Jeffrey Modell Centers Network?*
Medical Documentation
Please upload a letter of support with your medical institution's letterhead.
Additional Supporting Documents

Optional. Accepted formats: PDF, DOC, DOCX, JPG, PNG. Maximum 4 MB per file, 20 MB total.

Description of Request
Financial Information
Are the parents able to continue working?*
Applicant Certification and Acceptance

Applicants will receive a response within 14–21 days of receipt of the completed application. I certify that all information provided is accurate and complete to the best of my knowledge. I confirm that I have read and understand the Roots & Wings program guidelines. I am aware that any fraudulent statements or claims may be subject to penalties and immediate dismissal from the Program. I will acknowledge the Jeffrey Modell Foundation in all related materials and publications that result from the Program. My signature below confirms my acceptance of these terms.


Have questions?

We're happy to help. Just reach out at info@jmfworld.org.

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