Get Support

For Patients

Terminally ill patients apply to gain financial support during the most trying of times. BJF helps patients expand their social, work, and family networks to spread the word and fundraise on their behalf. Every patient and their community is supported through these donations and they will help future patients as well. As a 501(c)(3) organization, donating through BJF makes every dollar count. Get in touch to find out how BJF can help.

We will need to gather further information, including but not limited to, the items listed below;

Financials:

Monthly/Current Bills
Income prior to prognosis, must submit W2 or tax returns from prior year
Current income/disability
Spouse/Family income
Most recent bank statements
Bills/Invoices for (large) purchases in the last year
Any files from previous litigations or previous attorneys
All insurance policies, including life insurance
IRAs, 401Ks, Stocks, other investments
Life Insurance

Debt:

Credit Cards
Student Loans
Car Payment
Vehicle or Boat Title(s)
Recent bills from every creditor
Bankruptcy Kit (if applicable)

Fill out the online form or download

Step 1 of 4

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Birthdate*
Month
Day
Year
Gender*
Marital Status*
Citizenship*

Employment Status
Company*
Address*
Street Address Address Line 2 City State ZIP Code
Work Phone*
Job Title*
Approximate hours worked per week*
Manager Contact Information
Manager's Name*
First Last
Manager's Email*
Manger's Phone*
May we contact your manager?*

Emergency Contact Information
Name*
First Last
Relationship*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Family Member(s)
Name(s) and Relationship*

Our Partners

Get Support

For Patients

We will need to gather further information, including but not limited to, the items listed below;

Fill out the online form or download

Step 1 of 4

Medical Information

Current Health Insurance

Employment Status

Manager Contact Information

Emergency Contact Information

Family Member(s)

Our Partners