Travel Fund Application

Apply for the Lupus Kids Travel Fund

The Lupus Kids Travel Fund provides one-time travel grants of up to $500 to assist children and teens with Juvenile SLE (Lupus) with the travel costs around their medical treatment or care. Please use the form below to apply and we will reach out soon. Thank you!

Name or, if under 18, Parent or Legal Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name and Age (if under 18)

How did you hear about us?

Please share why you are applying for the Lupus Kids Travel Fund and how it can help you or your child