Application Checklist
To ensure your application is processed quickly, please provide all of the following documentation to Kristin Matus-Kelso at kristin@nfed.org.
Core Requirements (Required for all applicants)
☐ Completed Application Form: Ensure all sections are filled out entirely.
☐ Two Recent Photos: Please include two clear photos (at least 2”x3”) of the affected individual:
- Front View: A forward-facing portrait.
- Side View: A profile portrait.
☐ Medical Confirmation: Provide one of the following to confirm the diagnosis:
- Physician’s Letter: Must be on official letterhead, signed by a primary physician (MD/DO, not a dentist), and detail specific clinical manifestations (e.g., issues with hair, teeth, sweat, or nails).
- Genetic Testing Report: An official lab report confirming the diagnosis.
☐ Active NFED Membership: You must be a registered member. If you haven’t joined yet, register for free at nfed.org/join-us/.
Specific Requirements
| Dental Treatment ☐ Fill out and sign the Treatment Assistance Application Care Provider Statement. ☐ A statement from the attending dentist, making sure missing teeth are identified. Example can be found here. ☐ A detailed narrative of the treatment plan; outlining all treatment, anticipated time frames and costs of each treatment. Example can be found here. ☐ A dated, full-mouth digital x-ray or panorex. ☐ A dated, diagnostic, intra-oral photograph. ☐ A completed w-9. Download a blank copy. | Non-dental Treatment ☐ If requesting cooling equipment, your documentation must explain why the patient is at risk for overheating and why the product is medically necessary. ☐ Official Quotes: If you are requesting a window air conditioning unit, cooling vest, or wig, or other medical assistance request you must include a formal price quote for the item. |