Assessment Result: Children’s Medical

Child is eligible to apply for aid.

You may proceed to download the full application by clicking the button below.

Please follow all instructions to complete and submit the application.

Instructions:

It is important to complete ALL parts of the application. If a question does not apply, mark N/A (not applicable). Incomplete applications will be returned and you will be required to complete a new application.

It is the responsibility of the applicant to retain copies of the information you have provided to the Jones Foundation. The office will not copy the application or any documentation you have provided.

If mailed, it is your responsibility to verify receipt with the office. Make sure to have the correct postage; we will not accept POSTAGE DUE items.

This application must be hand delivered or mailed to the Jones Foundation as quickly as possible or the Jones Foundation may no longer consider your child(ren) eligible for a financial grant.

You must provide copies of the following:

  • PREVIOUS YEAR COMPLETE TAX RETURN
  • MOST RECENT PAYSTUBS REFLECTING YEAR TO DATE EARNINGS
  • PROOF OF ALL ADDITIONAL MONTLY INCOME FOR PREVIOUS YEAR, AS LISTED ON PAGE 2
  • COPIES OF MEDICAL AND DENTAL INSURANCE CARDS
  • COPY OF STATE ISSUED BIRTH CERTIFICATE FOR EACH CHILD FOR WHOM YOU ARE REQUEST ASSISTANCE

 

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