Disaster Relief Fund Application

In light of recent natural disasters, the Boomer Esiason Foundation created a fund that directly assists those families in the cystic fibrosis community affected.

Directions for Applying for BEF Disaster Relief:

Applicants must complete an official application.
A letter from the patient’s social worker/physician stating how much money is needed and where the funds should be allocated. Please specify reasons for relief (i.e. lost items, damages, etc.). The more detail this letter provides, the more attention the evaluation committee will give your application.
Please include invoices where applicable.

*Note – grant payment will be made directly to third parties only in a one time payment. Grant allocation conditions may vary.

**BEF reserves the right to request more documentation.

Please email Chris McEwan (disasterrelief@esiason.org) or call 646.292.7939 if you have question about the program or would like to make a donation.

Apply Online

Name*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Birthday*
MM slash DD slash YYYY
Number of people with CF in my household:*
CF Center*
Have you applied for and received other types of disaster relief aid?*
- Yes
- No
Have you ever been convicted of a crime?*
- Yes
- No
If yes, please explain.
Additional Documentation
Upload Social Worker/Physician Letter and Invoices*
Drop files here or

Max. file size: 512 MB.
By submitting this application, I certify that the information presented in my application is accurate and complete. I understand and agree that any inaccurate information, misleading information, or omission will be cause for the rescission of any grant offered to me. BEF may verify any and all parts of my application materials.*
I agree to the above stated policy.
CAPTCHA

Other Ways to Submit Your Application:

You can send the application form in one of three ways:

Please download and complete the application form:

Application Download

Mail the completed form and supplemental materials to:

Boomer Esiason Foundation
Attn: Chris McEwan
200 B Armstrong Road
Garden City Park, NY 11040

Email the completed form and supplemental materials to:

DisasterRelief@esiason.org

Fax the completed form and supplemental materials to:

646.292.7945