The AAMDSIF PNH Patient Travel Assistance Fund is available to U.S.-based PNH patients for up to $800 in travel assistance per patient, per year, to see a PNH specialist or get a second opinion from a PNH specialist. Grantees will be permitted to travel with one companion utilizing funds from the grant. Grants will be awarded based on the thorough completion of the required application form and the submission of all required documentation. Patients are required to submit verification of the PNH diagnosis, confirmation of the appointment with the PNH specialist, and to agree with the qualifying requirements regarding eligible expenses for this grant.
The AAMDSIF PNH Patient Travel Assistance Fund is administered by the PNH Patient Committee which is solely responsible for the final determination of the amount of travel funds (if any) awarded to applicant. The application form is available in Adobe PDF and Microsoft Word formats. Please download and complete the application, using the format that works best for you. The AAMDSIF PNH Patient Travel Assistance Fund application must be signed and dated and incomplete applications will not be considered.
Applications must be submitted in advance of the appointment for consideration. To submit your completed application, please send an email to firstname.lastname@example.org. Incomplete applications will not be considered. All questions and communications regarding the AAMDSIF PNH Patient Travel Assistance Fund should be emailed to email@example.com or by calling (800) 747-2820 x2. Applications are reviewed regularly by the PNH Committee, however it can take several weeks for a response.
|2023 PNH Patient Travel Assistance Fund Application - PDF||99.07 KB|
|2023 PNH Patient Travel Assistance Fund Application - WORD||81 KB|