CLOVES Syndrome Community Family Assistance Program Application

The CLOVES Syndrome Community (CSC) Family Assistance Program provides financial relief to families impacted by CLOVES Syndrome. We are a community that understands CLOVES Syndrome and the associated financial burdens. Our mission with the CSC Family Assistance program is to alleviate some of the costs associated with medical care, medical-related travel, and other CLOVES-related needs.

To qualify you for this assistance program, you or your child must be:

  • Diagnosed with CLOVES Syndrome

Financial assistance must be associated with the treatment, travel, medically needed equipment or expenses unique to an individual living with CLOVES Syndrome.

Some examples of qualifying requests are below, but are not limited to:

  • Costs associated with travel and lodging for medical treatment
  • Cost of medical equipment associated with the treatment of CLOVES Syndrome
  • Medical expenses from co-pays/deductible and costs associated with genetic testing
  • CLOVES Conference related costs

Application Process

  • Complete the application in full, including an explanation of the reason for your request.
  • Identify the amount of financial assistance you are requesting/seeking. Financial assistance will be determined on a case-by-case basis depending on need and CSC’s ability to assist.
  • Attach any relevant receipts/documentation of your expenses incurred equal to the amount you are requesting.
  • Attached proof of CLOVES diagnosis.
  • Once your application is received you will be notified by phone or email of your application review date and timeline for notification of financial assistance being granted by CSC.
  • Applications will be reviewed by our Board of Directors at the next scheduled meeting. If you express an URGENT need, the board will aim to review within one week of receipt of a complete application.
  • For those who receive financial assistance, you will be required to complete a survey, so we may learn from your experience.
  • Depending on circumstances and needs, you may be asked to disclose additional financial information.

Your privacy is a top priority of the CLOVES Syndrome Community Board of Directors. Information requested is necessary only to process your application and determine eligibility. Disclaimer: CLOVES Syndrome Community is a 501c3 non-profit organization and does not discriminate against age, gender, sexual orientation, race, disability or religion.

Please do not send any information containing social security numbers.

Any questions, please contact [email protected] or 833.425.6837

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