Application

Eligibility Requirements

-Must be 18 years old or younger
-Must be treated for medical hair loss in Illinois

-Referral letter from your treating doctor

Important Notice: If selected, funds will be sent directly to business where wig is being purchased.

To apply for financial assistance, you can:
(1) Complete electronic form. **No download necessary. Form is provided below.**
Note: You will not be able to save any work in progress.

(2) Print and send in a completed paper copy.
Note: Please make sure to read all instructions to prevent delays in your application process.

Electronic Application Form

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.