Patient Travel Fund Related to Clinical Trials

The AA&MDSIF provides financial assistance, up to $500 per family, per year for low-income families to cover ONLY TRAVEL EXPENSES for patients or parent(s) of a minor patient. This reimbursement is only for patients who are traveling to determine their eligibility or to participate in a clinical trial. Patients must supply travel receipts in order to be reimbursed. First-time applicants will be considered before applicants who have applied previous years.

APPLICANTS MUST:

Have a proven, significant need for financial assistance to travel to a clinical trial location
Have an appointment to determine eligibility OR be formally accepted into an Institutional Review Board approved medical clinical trial, located in the United States, for treatment of bone marrow disease such as aplastic anemia, myelodysplastic syndrome, or paroxysmal nocturnal hemoglobinuria

The AA&MDSIF will reimburse up to $500.00 per family to travel by plane, train, bus or automobile, and for lodging expenses. W-2 tax forms, written ticket confirmation, travel receipts and confirmation from the hospital's Clinical Trial Coordinator must be provided to AA&MDSIF in order to receive reimbursement.

Download and complete the application form and submit by fax to 410.867.0240, or postal mail to AA&MDSIF, PO Box 310, Churchton, MD, 20733. Contact the AA&MDSIF and request this form be faxed or postal mailed to you. If you have questions or need additional information, please call the AA&MDSIF staff at 410.867.0242 or 800.747.2820 or email clinicaltrials@aamds.org.

^{Last Modified: December 20, 2007}