How does a family apply for the Fund?
The application can be downloaded from this site. You may fill out the
application form using your computer and then print it and mail it to
the address below. You may also print the blank application form and fill
it out by hand and mail it. To maintain confidentiality, the application
form cannot be transmitted electronically.
Currently the application is available only in English.
If you need help in translating or completing the application, please
call the 800 number located at the bottom of each web page and the Commission
Staff Director will assist you.
Download
the application form (Word
fill-in form)
Download the application instructions (Rich-Text)
To request that an application be mailed to you, please
call or write:
Catastrophic Illness in Children Relief Fund
Division for Perinatal, Early Childhood, and Special Health Needs
Massachusetts Department of Public Health
250 Washington St., 5th Floor
Boston, MA 02108-4619
Phone: 1-800-882-1435
TTY 617-624-5992
