Jorge Nation Foundation, Inc. Dream Trip Application

(Please follow all directions and answer all fields to the best of your ability)

All medical and private information obtained is considered confidential and is not discussed with any third parties unless it is necessary for the Dream Trip and the applicant’s parent(s) or legal guardian(s) has/have given JNF consent.

Click here to read the requirements for a Dream Trip.

  • Date Format: MM slash DD slash YYYY
  • Important: You will receive email confirmation with additional request for information.
  • Date Format: MM slash DD slash YYYY

SPECIAL INSTRUCTIONS:

Upon submitting your application by clicking the SUBMIT button above, you will receive a confirmation email with a request for the documents below. Your application will not be complete unless you submit the following:

  1. Medical statements from the Dream Trip candidate’s medical providers confirming the applicant’s condition or illness, if applicable; and
  2. Medical clearance from the Dream Trip candidate’s physician(s) for the desired Dream Trip destination and dates ; and
  3. Proof of Identification for the applicant, if any, and parent(s)/legal guardian(s); and
  4. A brief written statement discussing why the applicant should be considered for the Jorge Nation Foundation’s Dream Trip, including a description of the applicant’s illness or medical condition and a description of the applicant’s desired Dream Trip. Add anything you think will be helpful to the Dream Trip Committee in its confidential consideration of your application. Please limit the written statement to two (2) pages total, double-spaced, and twelve (12) font.

PLEASE NOTE: We may require additional information from you and/or the Dream Trip candidate, including documentation from his/her medical providers or the family, in connection with the Dream Trip Application before we grant a Dream Trip to a candidate.