Important: Please read our assistance guidelines thoroughly. We’re seeing an increase in ineligible requests, which unfortunately must be denied.

Assistance Needed?

Is someone you know facing a medical challenge and in need of support?
The Travis Burkhart Foundation may be able to help. Simply complete the request form below to apply for assistance. Before submitting, please take a moment to review our guidelines to ensure the request meets our qualifications.

Types of Assistance Provided

All assistance provided must be medically related expenses.

The Travis Burkhart Foundation offers assistance in the form of food and gas cards, as well as help with hotel and medical expenses—but only when these expenses are directly tied to the individual’s medical treatment. All support provided must be medically related.

Requesting Assistance for an iPAD or dme?

If you are requesting an iPad or DME, a Letter of Recommendation is required.
This letter must come from the individual’s primary care doctor, teacher, or therapist and be printed on official business letterhead. It must include the full name of the individual the iPad is being requested for. Please note: iPad grants are limited each month.

Letters can be mailed to:
TBF
10274 N 200 E
Plainville, IN 47568

Or emailed to:
travisburkhartfoundation@gmail.com

assistance Request Form

Consent & Acknowledgment
By submitting the form below, you authorize the Travis Burkhart Foundation (TBF) to share the provided information with its Board of Directors for the sole purpose of evaluating your request for assistance. Your information will not be shared outside the Foundation and will be used strictly to determine the level and type of support needed.

By applying, you confirm that all information submitted is truthful and that any assistance received will be used solely by the individual named in the request.

For recipients receiving ongoing or monthly support:
An updated Letter of Recommendation must be submitted annually. This letter must come from a licensed doctor, therapist, or professional care provider and confirm that the individual is currently under medical care. The letter must be on official business letterhead and include the recipient’s full name. Failure to comply will dramatically impact your future assistance.

Please note: Submission of this form does not guarantee assistance. All approvals are based on the availability of funds at the time of the request. Please allow a minimum of 7 days for review. If additional information is needed to process your request, a TBF team member will contact you.

Please complete and submit the form below to begin the review process.