To be considered for financial assistance, the applicant must have:
- A completed Financial Assistance Application (see form below)
- A confirmed PFIC or related disease (including BRIC) diagnosis, confirmed by physician or casework on hospital/clinic letterhead; or Medical Eligibility form completed by a physician (**May substitute this requirement by providing public social media page or CaringBridge page sharing information about PFIC diagnosis and/or journey at the decision and discretion of the PFIC Executive Director**)
- A signed program waiver (See Program “Terms and Conditions”)
Additional Information About the Financial Assistance Application
- A detailed description of need is highly recommended. Your description of need helps PFIC Network assess the level of need among applicants.
- You may apply as many times as needed throughout the year. However, PFIC Network will award assistance a maximum of one (1) time per calendar year per family.
- The PFIC Network will ONLY make payments directly to third party service providers, not to the family directly. (Ex: For assistance with an electric bill, PFIC Network will make the payment directly to the electric company).
- The third-party bill(s) MUST be provided, if approved, before any assistance will be provided.
- PFIC Network will not award funds for emergency services, such as utility shutoff notices.
- The PFIC Network Board of Directors has final approval of all awards.
- If you need assistance applying or securing the required documentation to submit an application, please contact us.
**Applicants must provide documentation supporting their application prior to receiving funds. PFIC Network will not disburse funds without documentation.**