Miracle for Mateo
501c3 Non-Profit
Organization

Application for Funding & Support

Helping families manage life while they wait on their miracle.
Miracle for Mateo supports families with a chronically or terminally ill child, who are struggling financially due to their child's life threatening illness and lengthy hospitalization, by "helping families manage life while they wait on their miracle."
Miracle for Mateo provides financial support for families with dependent children who: have complex congenital heart disease or another life threatening illness, and are struggling through a lengthy hospitalization of greater than 30 days, are waiting for transplant, or who are living at home on hospice care. Miracle for Mateo accepts applications monthly and reviews completed applications on the third Tuesday of each month. Miracle for Mateo offers support to families who have a child receiving medical treatment in the Tri-State area (NJ, DE and PA) by providing funds for: hospital cafeteria meals, utility bills, living expenses, gas and travel expenses, and/or a wristband bracelet fundraiser.
 
Please complete the following application as completely as possible, and return the parent portion (including the release form) and social worker portion together by submitting this application online or mailing to Miracle for Mateo Paredes, Non-Profit Organization, PO Box 101, Shiloh, NJ  08353.
Should you need more information, please email Jennifer Spera at miracleformateo@yahoo.com  or if unable to email, please text Beth Daddario at (609) 501-2328. To learn more about Miracle for Mateo, please visit our website at http://www.miracleformateo.org/. If you have difficulty submitting your application online, applications may also be scanned and emailed to miracleformateo@yahoo.com
 
Completed applications will be reviewed on a monthly basis at the Miracle for Mateo Board Meeting on the third Tuesday of each month. Miracle for Mateo looks forward to helping make this time in your life a bit more manageable and supporting you and your family in any way we can.
 
 PARENT PORTION OF APPLICATION

Child’s Name*
Child's Date of Birth*
Child's Place of Birth*
Ethnicity
Who is your Social Worker/Child Life Specialist?*
Mother's Name*
Permanent Address*
Father’s Name*
Permanent Address (if not same as above)
Who should we contact with any questions?*Mom   Dad   
How should we contact you?*Email   Text   Mail   Facebook  Phone   
Phone Number(s) Cell
Other
Email(s)*
Could Miracle for Mateo contact you on Facebook?Yes   No   
If yes, please provide full name on Facebook
Please LIKE Miracle for Mateo so that we can find and contact you more easily. Thank you.
If we need to mail something to you, which address should we use?*
Are you currently staying at a Ronald McDonald House?Yes   No   
If yes, at which Ronald McDonald location are you residing.
What languages are spoken in the home?*English   Spanish   
Other
Is the child hospitalized at this time?*Yes   No   
Name of Hospital
Unit
How long has the child been hospitalized?*
What is the child’s current diagnosis?*
Does the child have any siblings? If so, please list names and ages of siblings below.*
Do you have anyone helping you care for your other children?*
Have you ever held a benefit dinner or event to raise funds for your family?*Yes   No   
*NOTE: If you are requesting assistance with a utility bill, travel expenses, childcare, or personal items, Miracle for Mateo will need to know where you shop for personal items, where you purchase gas and if you primarily need hospital cafeteria gift/meal cards. In order for us to pay a bill, we need to know the account number, the name of person on the account, the amount of the outstanding bill and a phone number for the company needing payment (if at all possible).
Please explain how your current situation has affected your family, and what your greatest needs are at this time. Thank you.*
Note: If you are submitting this application on line, please note that by submitting your application online, Miracle for Mateo will consider these forms signed and authorized.
Signature of Mother
Signature of Father
Date
*NOTE TO PARENTS: If you will be mailing in your application, please read and sign the Release Form on the following page. Thank you. If you are submitting this application on line, please note that by submitting your application online, Miracle for Mateo will consider these forms signed and authorized.



Social Worker and/or Child Life Specialist Portion Form

Release Form