HOUSING APPLICATION

 
The Live4Evan Organization offers a one bedroom, fully furnished apartment within 2 blocks of Boston Children’s Hospital (BCH) to families whose children are receiving cardiac care. The apartment is reserved for families traveling more than 50 miles from BCH and who are staying for a minimum of two weeks. The maximum occupancy for the apartment is 4 people. Parking may be available on request, but must be paid for by the family.

If Live4Evan is able to accommodate your stay, you will receive a lease agreement and instructions for submittal of funds required to complete the application process.

There is no charge for staying in the Live4Evan apartment. However, an initial fee of $100 will be required upon completion of the application process and signing of the lease agreement.

PATIENT INFORMATION

Patient's First Name:

Patient's Last Name:

Diagnosis / Reason for Current Trip:

APPLICANT INFORMATION

Primary language:

HOUSING NEEDS

How many family members will be staying?:

Names/ages of family requiring housing:

Anticipated arrival date:

Anticipated departure date:

Special Needs / Accommodations Required:

CURRENT TREATMENT INFORMATION

Social Worker Name:

Social Worker Email:

Social Worker Phone:

Home Hospital:

Treating Doctor:

BY CLICKING SUBMIT YOU ARE AGREEING TO THE FOLLOWING:

  • Live4Evan requires that all families housed in our apartment also maintain a permanent residence to return home to. By clicking submit, I hereby certify that the address above is the permanent residence for my family, and agree to notify Live4Evan immediately if that changes.
  • Live4Evan requires confirmation by a social worker at BCH that applicants already have appointments/procedures scheduled prior to approval for housing. By clicking submit, I hereby certify BCH to confirm or deny that my child has appointments scheduled in the Heart Center.