Application

Eligibility Requirements

  • Must be 18 years old or younger

  • Must be treated for medical hair loss in Illinois

  • Completed application

  • Referral letter from your treating physician

Application

To apply for financial assistance, you can:


(1) Complete electronic form.

(2) Print and send in a completed paper copy. Please be sure to read instructions on how to complete the downloaded application form. 

Additional Forms

255 N. Buffalo Grove Rd. #7366

Buffalo Grove, IL 60089

(224) 543-6533  |  info@HairForYouFoundation.org

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Hair For You Foundation is a 501c(3) nonprofit company certified by the IRS in 2013. EIN # 32-0412093

© 2013-2019 Hair For You Foundation, Inc.

All rights reserved.