Welcome to the UnitedHealthcare Children’s Foundation online application.
The online application system will email you some important information after you submit your application. The email will come from "UHCCF Customer Service" within 24 hours. Since our email is automated, you may want to look in your SPAM email folder if you do not receive the email within 24 hours. Please complete the application once you start. There is not a way to save your application and return at a later time. Do NOT click on the back or forward arrows.


Grant Application Process

PERSONAL INFORMATION
 
All fields marked with an * are required
*Primary Parent/Legal Guardian First Name *Primary Parent/Legal Guardian Last Name
       
*Are you the mother, father or legal guardian?
 
*Does the child have a secondary parent or legal guardian you would like to add to this application? If yes, please add below.
 
Secondary Parent/Legal Guardian First Name Secondary Parent/Legal Guardian Last Name
   
Is this the mother, father or other legal guardian?
*Primary Parent/Legal Guardian Home Phone Number
Example (xxx)xxx-xxxx    
Primary Parent/Legal Guardian Work Phone Number
Example (xxx)xxx-xxxx  
Primary Parent/Legal Guardian Cell Phone Number
Example (xxx)xxx-xxxx  

*Primary Parent/Legal Guardian Mailing Address:
*Street address, P.O. box, c/o  
Apartment, suite, unit, building, floor, etc.
*City    
*State  
*Zip Code    
*Primary Parent/Legal Guardian Email Address
(Please Note: Grant award decisions will be communicated electronically to the email address provided below. If you do not have an email address, please sign up for free email account with Yahoo, Hotmail, Gmail etc. You MUST enter valid email address - we will communicate with you via email.)
   

*Child's First Name *Child's Last Name
       
*Child's Social Security Number *Child's Birth Date
(Example 123456789, exclude dashes)     (Example MM/DD/YYYY)      
*Is your child a boy or girl?
 
Please check if the child's mailing address is same as the primary parent mailing address.
 
*Child's Mailing Address:
*Street address, P.O. box, c/o  
Apartment, suite, unit, building, floor, etc.
*City    
*State  
*Zip Code    
*Is this the first time you have submitted a UHCCF grant application for this child?
 
*Has this child received a previous UHCCF grant?
 
*Have you submitted any previous UHCCF grant applications for any other children in your family?