Request Financial Support from Julian’s Legacy Foundation

Julian’s Legacy Foundation has vowed to distribute a percentage of our yearly funds to individuals and families in need, helping ease the financial burdens that often come with life after a burn injury.

If you are a burn survivor, or a family member supporting a burn survivor, who is in need of financial assistance due to the ongoing challenges and lasting effects of burn injuries, please fill out the form below. Our goal is to offer support, relief, and hope to those navigating the difficult journey of recovery and rebuilding!

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Name *

First

Last

Email *

Phone Number *

Address *

Briefly describe your story and situation *

Approximate date of burn injury (mm/dd/yyyy) *

Are you currently receiving care from a burn center or hospital? *

• Yes
• No

Amount requested (if known)

Please share how this assistance will help you *

have 4 below

Please select your preferred method of receiving assistance *

• Check (By Mail)
• GoFundMe or other crowdfunding platform
• Zelle
• Direct deposit / bank transfer

Do you have a GoFundMe or another crowdfunding page? If so, please provide a link below

Disclosure 1 *

• I confirm that the information provided is true and accurate to the best of my knowledge

Disclosure 2 *

• I consent to Julian’s Legacy Foundation contacting me about my application

Disclosure 3 *

• I understand that submitting this form does not guarantee financial assistance

Disclosure 4 *

• I understand that my information will be kept confidential and used solely to review my request

Submit

We truly wish we could assist everyone who reaches out. While we may not be able to help every person, we are committed to doing our best to support you in any way we can.

Requests are reviewed yearly by our board members, with the next determination date in mid-December of 2025. We hope that as we grow, we will be able to review and decide on requests more frequently throughout the year. You will be notified if we are able to provide financial assistance, along with the next steps for receiving the funds. Thank you for your love and understanding!