Below is our application form for prospective recipients.
If you believe you would make a good candidate for assistance, simply fill it out and we will be in touch.
CJ3 Foundation Prospective Recipient Application
Every applicant’s story and requirements are unique. To better serve you, we at the CJ3 Foundation need to better understand who you are, what your particular quality of life challenges are, etc. Please help us to help you by providing forthright and detailed responses to the following questions. We understand this may not be an easy task, but it is an important step towards improving your wellness.