Those financially in need  of pursuing therapy alongside infertility treatment, are welcome to apply for the Chosen Therapy Grant. All applicants must be willing and able to receive treatment through our partner, Amanda Polk, LMSW.

Chosen Therapy Grant(s) funds will NOT be paid to the applicant or his or her spouse or partner; rather funds shall be paid directly to the healthcare provider, Amanda Polk, LMSW.

Chosen Therapy Grant(s) are limited by the amount of funds received via donations and are awarded as frequently as possible. All applicants will receive an email to confirm submission of his or her application, and certain selected grant recipient(s) will be contacted by Chosen. Announcement of such selected recipient(s) will be highlighted on social media within two months following the grant submission deadline. 

Applicant understands and agrees that submission of his or her application does not guarantee that he or she will be selected for a Chosen Grant.

Eligibility

Applicants must meet all the following requirements in order to be eligible for a Chosen Grant:

– Be a resident of and live in the state of Michigan or Ohio;
– Be less than 50 years of age;
– Have a diagnosis of infertility certified by a medical provider, with exception for: Applicants who are single, or part of a same sex relationship;
– Have no infertility insurance coverage or have exhausted benefits. If a patient has coverage for monitoring and/or medications, they will still be considered. Patient(s) would be responsible for any deductibles or copays;
– Be under the care or willing to be under the care of Amanda Polk, LMSW;
– Be able and willing to start treatment within 3 months following receipt of awared

*Considered applicants may be asked for additional documentation.

*Chosen Infertility Group follows all HIPAA standards, discarding all private information and materials immediately following the selection of an applicant.

1. Download and sign Permission to Release Information Including Photographs, Videos, Audio, Electronic, or Other Media Form by clicking here
2. Download and sign HIPAA Authorization Form by clicking here
3. Download and sign The Chosen Grant Overview Form by clicking here
4. Fill out Grant Application by clicking button below
5. Complete Wedge Video Interview by clicking button below
6. Have had a consult prior to grant deadline with Michigan Center for Fertility & Women’s Health