Before completing the form below, please be advised that we can only accept applications from families who are residents of the state of Pennsylvania and Maryland. Anyone residing in any other state does not qualify.
Also please be advised that our charity was set up to help families suffering from the loss of a child due to miscarriage, still-birth, or infant death. If your child was not an infant at the time of death, you are not eligible for assistance. We define an infant as a child under the age of ten months old.