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The Clara B. Farlow Foundation for Children of Surry County provides financial assistance and support to families who have children under the age of 18 with serious physical and mental challenges and/or illnesses.

What does the Foundation offer children?
For eligible children, the Foundation may pay for treatments such as:

• Doctor’s services
• Hospital confinement
• Surgical care
• Laboratory tests
• X-rays
• Orthopedic appliances
• Medical equipment
• Medical consultation
• Medical treatment
• Psychiatric counseling
• Physical therapy

Who can qualify for Foundation assistance?
Assistance is available to anyone who:
• Is under the age of 18.
• Has a serious physical and/or mental illness that is recognized by
   the Foundation.
• Meets the Foundation’s financial requirements.
• Must be a resident of Surry County, North Carolina.

The Foundation reserves the right, in its sole discretion, to determine the
issue of financial need.

What must the applicant do to qualify?
The parent or guardian must:
• Complete the application and provide proof of financial need
   where required.

How is privacy protected?
The Foundation will keep all information confidential. The Foundation may share information with medical, health and welfare programs as indicated on the Authorization for Release of Protected Health Information form.

Do I have a right to appeal a decision?
Decisions made by the Foundation are final and may not be appealed.

Application
Please mail the completed
application to:


Clara B. Farlow Foundation for
   Children of Surry County
580 Crossingham Road
Mount Airy, NC 27030


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