Aydens Army of Angels Application for Assistance Sickle Cell

1
Mom's/Caregiver Name* This field is required.
First Name
Last Name
2
Dads/Caregiver Name* This field is required.
First Name
Last Name
3
Warrior's Name* This field is required.
First Name
Last Name
4
Diagnosis/Stage* This field is required.
5
Photo of the ChildPlease Upload a photo of your fighter
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Photos may be used in AAOA marketing material and social media platforms
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6
Families Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Families Email* This field is required.
example@example.com
8
Social Workers Email* This field is required.
example@example.com
9
Social Workers Phone Number* This field is required.
Area Code
Phone Number
10
Type of Assistance Needed * This field is required.rent, utility, grocery, car payments.......
Rental/Mortgage Payment
Phone Bill
Date Night Pack
Car/ Insurance Payment
Grocery Cards
Social Media Sharing
Other
11
Statement for Account * This field is required.Please attach a copy of your lease, 5 Day notice, or utility payment that you are seeking financial assistance.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Must be a current Utility bill, we will not pay late fees or past due amounts.
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12
Family Income* This field is required.
Unemployed
$10,000-$20,000
$21,000-$40,000
41,000 and above
13
Letter of Verification from Social Worker/Doctor* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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14
Does the fighter receive Social Services Benefits?* This field is required.
Yes
No
15
Please share you family story and the reason you need assistance:* This field is required.
16
Please verify that you are human* This field is required.
17
Social Worker SignatureYour application is not complete unless it has been submitted by a hospital social worker, Child Life Specialist or authorized hospital personnel. By signing this application, you are attesting to the accuracy of the information on all pages, to the best of your knowledge. Fraudulent applications may result in institution being deemed ineligible for this program. Please be sure that the entire application is complete before submitting it. Incomplete applications will be returned, uploading unrequested documentation to complete the application will result in immediate denial. Please read our application qualifications prior to submitting your application. AAOA also has your permission to post and share the child's name, photo, and diagnosis, and fundraising links on all social media avenues owned by our organization.
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