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IBIDUNNI IGHODALO FOUNDATION - REGISTER FOR PIWC / APPLY FOR IIF GRANT 2017

Date Posted: 17/Jun/2017

The Ibidunni Ighodalo Foundation (IIF) is a non-profit organization created to raise awareness on issues pertaining to infertility and to provide grants for couples that require fertility treatments such as In Vitro Fertilization (IVF) and Intrauterine Insemination. We partner with highly reputable fertility clinics in Nigeria and with other donors to provide couples with the financial and material support they require during the treatments. We also provide the necessary psychological and spiritual support they require to deal with the pressures they face along their journey to conception.

 

*APPLICATIONS CLOSES 30/06/17


 

Terms & Conditions.

I certify that of the information provided in this application is complete and accurate.I authorize the release of the information contained in this application. I understand it is for the sole use of the foundation,its program participants,its representatives and/or agents collectively the foundation in order to assess my eligibility for participation in Fertility.

I authorize the Foundation to request and obtain from my physicians and any insurer any medical or other patient information related to my treatment infertility. I authorize the Foundation to share the information contained herein with the pharmacy that will dispense my fertility medication to me the pharmacy and participating fertility centers in connection with fertility. I agree to immediately inform the foundation if my income status changes and to provide any documentation that the foundation requests to verify the same.

I authorize the foundation to contact me directly to process this application.I understand that my application for assistance does not guarantee that assistance will be provided.I understand that eligibility for fertility is subject to approval under the criteria and requirements set forth herein and that the foundation reserves the right to change or terminate fertility without prior notice.

I agree to abide by this certification and authorization during my participation in fertility and to notify the foundation if aspects of my application, certification or authorization are no longer applicable.

I understand that neither the foundation nor the pharmacy are medical providers and by submitting this application with my signature below, I acknowledge and agree that neither the foundation nor the pharmacy/hospital shall be liable for any aspect of my current and future treatment. I understand that there are no guarantees that the procedures intended to assist in preserving fertility or the associated medications that maybe provided to me under IIF fertility will be successful in preserving my fertility. I understand the success rates of the procedures and I agree that neither the foundation nor the pharmacy/hospital shall be liable for any treatment failure.

I assume all risk of and financial responsibility for any loss or injury related directly or indirectly to my participation in IIF fertility and agree to indemnify and hold the foundation, hospitals and the pharmacy harmless from and against any and all costs, claims, demands, charges, liabilities, obligations or fees incurred or suffered by me as a result of or arising out of my participation in IIF fertility except for claims resulting wholly from the gross negligence of the foundation, Hospital or pharmacy.

I understand that if i qualify for IIF fertility, I may receive a limited quantity of certain medications from the hospital. I understand that if I receive such medications, IIF is under no obligation to provide me with additional medications.

I have discussed with my physicians the risks, side effects and other aspects of all treatment options.

I understand that the foundation is authorized as a “business associate” and that as a business associate, health providers are allowed to disclose my protected health information to the foundation based on the written assurances made by the foundation to the health provider that the information will only be used for the purposes of IIF fertility, that the information will be safeguarded from misuse and that the foundation will help the health provider comply with the law.

By clicking apply below, i certify that I have completely and accurately disclosed and at all times will completely and accurately disclose my medical history to all of my health providers including but not limited to any reproductive endocrinologist. I understand that the agreements under IIF fertility shall be construed and interpreted in accordance with the laws of the state without regard to its conflicts of law provisions.

 

***by clicking on the apply button you have accepted our terms and condition as stated above.

 

Method of Application

Interested and qualified? Click the Apply now button to send your application

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