B Kind Referral

B Kind provides assistance to families/individuals in need with food assistance, and medical and educational needs.

Who is eligible for B Kind?

Individuals (or a family member) with a Neurofibromatosis diagnosis living in the Contiguous United States. Self-referrals or referrals from immediate family members are not eligible.

Application Process

Please fill out the following form to the best of your knowledge. Thorough and detailed information will assist immensely. A B the Difference team member will be in touch once the form is received. Please note, this is the first step in the B Kind selection process, it is not confirmation that your nominee will be selected for relief.

Information for Applicants

Please feel free to share this B Kind informational form with your applicant.

"*" indicates required fields

Your Information

Your Name*

First Last

Your Email*

Your Phone*

Relationship to individual*

Self-referrals and referrals from immediate family members are not eligible.

Candidate Information

Name*

First Last

Gender*

As it appears on photo ID (if applicable)

Age of Nominee*

Hometown/State*

Email*

Phone*

Parent/Guardian Name

If under 18.

First Last

Parent/Guardian Email

Parent/Guardian Phone

Please describe in detail how B Kind assistance would benefit this individual/family?*

The B Kind Program provides relief with food assistance and medical and educational needs. Which category of relief would this family/individual benefit from? (Please be specific)*

Have you identified any other forms of assistance that we could provide to the NF community?

HIPPA Disclaimer*

Personal contact and medical information is protected by HIPPA laws. This family has given approval to share contact and medical information with B The Difference

Yes

How did you hear about B the Difference?*