Agnes Reynolds Jackson Fund Recipient Statistics

We ask that clinics receiving funding through the A.R.J.F. (Aggie Fund) provide the following information on patients receiving loans through our fund. If the patient has received previous grants through the Aggie Fund, please note this in the “Additional Notes” section. Please be sure NOT to include patient names.

Patient Information
Is Patient Employed
Is Patient a Student
 
 

More Information for Clinics:

Each month a representative of the A.R.J.F. or Aggie Fund will email you with a dollar amount based on our fundraising efforts, that is available for you to use as “loans” to patients for the month. We ask people to repay what they can when they can. We do NOT get their names, and if they are unable to repay, that is fine.

We ask you to fill out the statistics form on each individual, and to fill out the loan information sheet [PDF link here] and give it to the recipient. At the end of the month we will mail you a check to reimburse you for the loans made. If a patient needs help with transportation, please have them contact us directly.