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Ari Foss Foundation
Home
About
Resource Center
Cremation and Funeral Financial Assistance Program
Funding Request
Becoming a Fundraising Advocate
Crowdfunding Websites
Education and Resources Program
Statistics and Research
Volunteers
Frequently Asked Questions
Privacy Policy
Donor Information
Donor Information
Donor Recognition
Donor Report 2024
Newsroom
News
Press Release – Ari Foss Foundation Receives $15,000 Grant from Roper Saint Francis Physicians Endowment
Memorial Walk
Contact Us
© 2025 Ari Foss Foundation
Donate Now!
Funding Request
Helping Families when the Unthinkable Happens.
Cremation and Funeral Financial Assistance Program
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Request for Cremation or Funeral Financial Assistance
This form contains conditional logic, so the options you see will update based on certain selections. Our Cremation or Funeral Financial Assistance Program is limited by our available funds. If you would like to check for funds availability before submitting the from, please contact us. We will try to update this page when funds are not available.
Was the mother or baby a patient at MUSC or Roper St. Francis Healthcare when the stillbirth (intrauterine fetal demise 20+ weeks) or neonatal demise occurred?
(Required)
Yes-MUSC
Yes-Roper St. Francis Healthcare
No
Not Eligible for this Form
At this time, our online form is limited to MUSC and Roper St. Francis Healthcare referred patients only. Please contact us for program available. Our program is limited to SC residents and SC hospitals.
MUSC Referral - Shortened Form
This is our MUSC Referral shortened form that does not require financial information. MUSC’s approved Financial Assistance Form must be submitted or emailed by a MUSC employee.
Person Submittng the Form
Our preference is for one of the parents to submit the form, but we know the grieving process is difficult. We understand if a trusted individual is helping the parents during this difficult time. We encourage this type of support to the parents. However, we must contact one of the parent's to verify funding details.
Person is submitting the form is:
(Required)
Parent of Baby
Family Member
Friend
MUSC Employee
Roper St. Francis Healthcare Employee
Other
Your Name
(Required)
First
Last
Organization
(Required)
Title
(Required)
Phone
(Required)
Email
(Required)
Comments
(Required)
Comments
(Required)
Parent(s)'s Information
Mother's Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Mailing Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Is the baby's other parent present/involved?
(Required)
Yes
No
Father/Other Parent's Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Baby's Information
Name
(Required)
First
Last
Gender
(Required)
Female
Male
Was the Baby Stillborn?
No
Yes
Birth or Stillborn Date
(Required)
Month
Day
Year
Death Date
(Required)
Month
Day
Year
Was Baby Full Term?
(Required)
No
Yes
If no, Weeks of Gestation:
(Required)
Funding Request
We do not need all of the service provider(s) details at this time. The items marked as required are the information we need at this time to be considered for conditional approval. The other information is required for final approval and can be submitted via email within 30 days of conditional approval.
Type of Service
(Required)
Cremation (up to $500)
Funeral (up to $1,200)
See the Cremation and Funeral Financial Assistance Program details for funding and use limits.
Requested Financial Assistance Amount:
Will there be a balance due beyond what AFF will be paying?
No
Yes
If yes, how will this balance be paid?
Name of Crematorium/Funeral Home:
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
Email
Funeral Director Name:
First
Last
Name of Interment Location:
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
Email
Upload Invoices from Service Providers
Drop files here or
Select files
Max. file size: 256 MB.
Financial Information
MUSC Approved Financial Assistance Form
Max. file size: 256 MB.
Household Income
(Required)
$0-$35,000
$35,001-$75,000
$75,001-$125,000
Greater Than $125,000
Unknown - I am submitting on behalf of the family (aka not the baby's parent)
Household Income is defined as the total income for all members of the family living together. By submitting the form, you attest your answer is accurate given the best of your knowledge.
Form Submission
Acknowledgement
(Required)
I agree that submitting this form does not guarantee Ari Foss Foundation will approve this funding request and I agree to the below information.
The Ari Foss Foundation will review the form submission and follow up with the individual who submitted the form.
Invoices are considered part of the Financial Assitance form. The Ari Foss Foundation can give conditional approval without the invoices; however, final approval cannot be given without the invoice(s) from the service providers.
The invoice(s) must be submitted within 30 days of conditional approval or the conditional approval will expire.
The Ari Foss Foundation directly pays the facility/service providers. Under no circumstances can the Ari Foss Foundation reimburse an individual through the Cremation and Funeral Financial Assistance Program.
Signature
(Required)
Comments
This field is for validation purposes and should be left unchanged.