Mission Request Form

Children’s Flight of Hope provides air transportation for children to access specialized medical care. This service is provided to children under 18 years of age and one adult companion – a parent or legal guardian – traveling to confirmed medical treatment. Parent or legal guardian must accompany the child on all segments of travel, and reservations may not be split. Parent/legal guardian and the child must return as soon as treatment is complete and duration of travel may not exceed 1 year. Children must be deemed medically stable for air travel.

 

Returning Clients

For those who are established clients, you may continue to submit new requests for assistance. You will be asked to provide your child’s Client ID and Birthdate to validate that you are a returning client.

 

If you have any questions, please contact a Mission Delivery Specialist at 919-466-8593 option 2.


New Clients

Due to overwhelming requests for air transportation assistance, and our commitment to providing ongoing support to children who are currently enrolled in our program, Children’s Flight of Hope is not accepting new clients at this time. Please check back periodically as we hope to reopen enrollment in April.

 

Exception: If you have been referred to Children’s Flight of Hope directly through the American Airlines Miles for Kids in Need Program or a partner organization, please move forward with the application process.






Children's Flight of Hope is not able to fulfill requests from new clients within 14 days of the departure date. Exceptions will be make for clients referred through American Airlines Miles for Kids in Need.

Method of Travel Information

Children’s Flight of Hope works to provide the best method of air transportation based on each child’s unique medical need. Commercial flights and private aircraft options are available for those who qualify for our program, though private air travel is reserved for only those children who are unable to fly commercially because of their medical condition. Due to the high cost of private air travel, any private request must be requested and/or confirmed by the child’s physician.



If yes, please explain why the nature of the child’s condition would require private air travel
Child’s Information
In this section you will enter information related to the seriously ill or injured child in need of air transportation assistance. There must be an established medical appointment prior to CFOH accepting the request.










mm/dd/yyyy




 
lbs
You may approximate the weight for the child and the companion(s). This will be used to determine weight limits for the aircraft.



Please list all medications that will be traveling with the child.
Requestor’s Information
The person requesting air transportation assistance on behalf of the child should complete the following fields. If you are traveling with the child, please provide your name as shown on ID. 








If you are not a partner of American Airlines, please input "None"





 
lbs

mm/dd/yyyy






Please provide at least one (1) phone number.







We highly recommend you provide a valid email in order to receive important information from CFOH.


Companion Information
This person must be the child’s legal guardian or have been given legal consent to travel with the child.  Please provide your name as shown on ID.












Please provide the best phone number for the day of travel.








mm/dd/yyyy

 
lbs


Second Companion Information
This person must be the child’s legal guardian or have been given legal consent to travel with the child. Please provide your name as shown on your ID.






 
lbs







Please provide the best phone number for the day of travel.








mm/dd/yyyy

Emergency Contact Information
Please provide the information for someone not traveling with the child. 



If you have any questions during the process, please contact a Mission Delivery Specialist at 919-460-4334.

Financial Verifier Information
Prior to accepting a request, Children’s Flight of Hope requires verification of financial need provided by a third party professional (e.g. employer, social worker, banker, financial adviser) who is able to answer a brief survey regarding the family’s need for financial support. It will be used for the sole purpose of determining a financial need and will not be shared outside of CFOH staff. The financial verification is evaluated annually.

Government subsidy refers to such programs as Supplemental Security Income (SSI), Disability, SNAP Food Supplements, Medicaid, or other State or Federal programs.

Please send a copy of the government subsidy card or award letter to missions@cfoh.org.


This person must not be related to the child. Children’s Flight of Hope requires verification of financial need provided by a third party professional (e.g. employer, social worker, banker, financial adviser) who is able to answer a brief survey regarding the family’s need for financial support. It will be used for the sole purpose of determining a financial need and will not be shared outside of CFOH staff.  Please provide appropriate answers to the questions above before moving forward.



Place of employment for the Financial Verifier









If you have any questions during the process, please contact a Mission Delivery Specialist at 919-460-4334.

Destination Physician's Information

Please provide information below for the child’s destination physician. This person will be contacted to ensure a medical appointment has been secured prior to CFOH accepting the request.














Referring Physician's Information

Please provide information below for the child’s referring physician or the physician that the child has seen most recently. This person will be contacted to obtain medical approval for air travel.















If you have any questions during the process, please contact a Mission Delivery Specialist at 919-460-4334.

Request Form

In the fields below, please give our mission delivery representatives an idea of how we can best be of assistance. Specific information about the child’s condition, travel requirements, and special needs are most appreciated.



Children’s Flight of Hope is not a medevac service as we are able to only provide air transportation assistance to children stable enough to travel without medical personnel or significant intervention.

Please explain why the child's condition is not stable.



In the field above, please indicate the specific needs for mobility aids or the type of assistive device that will be used during travel.


If yes, please explain the prescribed flow of oxygen, the make and model of the concentrator, etc. Clients are responsible for providing all medical equipment including oxygen. Some restrictions apply when using oxygen on an aircraft.


Please explain all medical equipment, medications, and food supplements with which you will be traveling. All items must be provided by the child's family.

lbs

Please describe what you will bringing on the plane with you
Travel Request Details

Please indicate your preferred departure and arrival location. Based on your current knowledge, provide a departure and arrival date that correlates with the medical appointment date and time. CFOH strongly recommends that clients plan to travel the day prior to the medical appointment in order to avoid any unexpected travel changes. 











In the field above please provide details of the medical appointment to which CFOH is providing air transportation assistance.

An appointment must be established prior to CFOH accepting the request for assistance. If you are waiting for an appointment date from your physician, please leave this field blank.

ex: 4:00PM

An appointment must be established prior to CFOH accepting the request for assistance.

ex: 4:00PM

Please choose Round Trip if you know or if you have an estimated return date
If you are unsure of the return date, please select this box. In the "Earliest Return Date" field please enter your best guess for the return date.

Please indicate your earliest expected date of return. We understand the nature of the medical appointment may change the return date.

Please indicate your earliest expected date of return. We understand the nature of the medical appointment may change the return date.


In the field above, please indicate any other considerations or concerns when coordinating air transportation assistance.
If you have any questions during the process, please contact a Mission Delivery Specialist at 919-460-4334. 

Mission Delivery Policies & Procedures

Statement of Understanding between Children’s Flight of Hope & Client Representative

Children’s Flight of Hope, Inc. (“CFOH”) is a nonprofit organization that evaluates flight requests for no cost, third party air transportation for seriously ill or injured children to obtain medical treatment and arranges such transport for accepted flight requests. “CFOH” is willing to take such steps, provided that partner organization representatives and qualified adult travelers meet the requirements in these Mission Delivery Policies & Procedures. “CFOH” reserves the right to decline or terminate flight requests for any reason, including without limitation for failing to adhere to the standards set forth in these Policies.

General

·         “CFOH” requires at 21 days to evaluate a flight request, unless “CFOH” – in its sole discretion – waives this requirement because of extenuating circumstances.

·         “CFOH” arranges for no charge air transportation solely for the child requiring medical support and one companion.

·         Those flight requests that are approved by “CFOH” are filled on a first-come, first-served basis until limit is reached as determined by “CFOH” in its sole discretion.

·         “CFOH” retains the right to accept and deny flight requests in its sole discretion.

·         “CFOH” does not arrange for ground transportation to and from an airport to a medical facility or other overnight accommodations.

·         Medical appointments at a destination facility must be established by partner organization representative or qualified adult traveler prior to “CFOH” accepting a flight request.

·         Because of frequent and often unavoidable travel changes, “CFOH” strongly recommends that no flights are booked for the same day as a medical appointment.

·         “CFOH” does not provide air ambulance transport, life support, medical equipment, or other medical assistance of any type.  The Child must be able to board the aircraft and be able to sit in the seat during the flight. 

Commercial Flights
For accepted mission requests:

·         “CFOH” does not pay commercial airline baggage fees.

·         “CFOH” will work with commercial airlines to arrange for assignment of best seats available, but negotiating seat changes is the adult traveler companion’s sole responsibility.

·         In general, “CFOH” does not transport children with medical equipment.  You are responsible for providing any permitted medical equipment that may be needed during the flight (including Oxygen).  Medical equipment may be subject to Federal regulation, and is subject to the policies of, and approval by, the airline.  You are responsible for obtaining any required approvals from the airline.  You should be prepared to provide medical documentation for all medications, feeding supplements, medical equipment, etc. that may come into question during airport security screenings.

·         “CFOH” makes every effort to obtain wheelchair assistance as needed but is not responsible for the lack of acknowledgement of this request by the airline or lack of support at any airport.

·         Ticket Changes:

o  Airline Changes/CancellationsIf the airline cancels a flight due to weather, mechanical issues, or other circumstances it is the responsibility of the airline to provide an alternative flight as close to the original destination and arrival time as possible. You should work directly with the airlines to reschedule canceled flight and communicate the new travel plan to “CFOH” representative by calling 919-460-4334. “CFOH” will not book another flight as a result of an airline directed cancellation. You should communicate possibilities of travel interruptions with the destination physician/medical team and make adjustments to the child’s treatment plan accordingly.

o   Client Changes/Cancellations: If a flight needs to be changed or canceled due to the Child’s needs, please contact “CFOH” directly to determine the best course of action. “CFOH” will work with the airlines to make necessary changes. If the ticket change is voluntary (e.g. early release from medical facility) any and all fees and costs associated with ticket changes will be paid for by client. If the required change is unavoidable due to a medical emergency of the Child, a description of the medical need must be documented and provided by the Child’s physician. In this case, “CFOH” will incur the cost of a reasonable change fee. If documentation satisfactory to “CFOH”, in its sole discretion, is not provided, the client is responsible for all change fees.

Travel Tips

·         All air travelers should plan to arrive 1.5 to 2 hours prior to departure for all domestic flights and 2 to 3 hours for international flights.

·         Travelers should adhere to all baggage restrictions to avoid extra fees or having to leave behind items.

·         “CFOH” encourages travelers to understand and take advantage of priority boarding during travel. These opportunities can help cut down on the stress of boarding and waiting for departure.

·         If additional aid is needed during travel, do not hesitate to request assistance from airline customer service or TSA representatives.

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If you have any questions during the process, please contact a Mission Delivery Specialist at 919-460-4334. Please be patient while waiting for the form to submit. When the form has been submitted, you will be redirected to the CFOH website. Should you receive an error, please call the Mission Deliver Specialist at the number listed above. 

In order to recall previously submitted information, you will need to enter the Client ID and child’s date of birth on the next page. The Client ID is an 8 digit alphanumeric identifier that you received recently by mail or via email. Should you need assistance, please call 919-460-4334 or email missions@cfoh.org and a Mission Delivery Specialist will contact you.


Once you are ready to input the Client ID and date of birth, please select submit.

Thank you for reaching out to Children’s Flight of Hope. If you answered no to any of the previous questions, we are unable to provide air transportation assistance at this time. We ask that you complete the information below which will only be used to help in future expansion of our services. Once you have submitted this information, you will be redirected to the Resources page of our website where you may find another organization that is better suited to your needs.






City, State

City, State

International Mission Requests

Children’s Flight of Hope (CFOH) provides international air transportation support to organizations and individuals who have been referred through American Airlines (AA) Miles for Kids in Need medical transport program. Transportation is restricted to medical facilities and services provided in the 48 contiguous states, Alaska and Canada (provided AA has service).

 

Program Details

  • Application must be completed in English
  • Transportation to/from medical conventions, conferences, training or teaching seminars, research/clinical studies, camps, fitness programs, etc. is not permitted
  • Transportation related to adoptions is not permitted
  • Requests may not be for emergency or last minute travel
  • No stopovers are permitted
  • If request is approved, it is the sole responsibility of the passengers to provide valid documents (driver’s license, passport, visa, power of attorney if child is traveling with legal guardian, etc) for travel.
  • Children's Flight of Hope is not liable for any expense incurred as a consequence of a flight cancelation or delay.

The below listed documents (word or pdf) that are required prior to CFOH accepting this request. You may upload the document during this request or email them to missions@cfoh.org.


Failure to provide required documentation may result in delays and possibly a declined request.

 

Personal Requirements

  • Copy of birth certificate or other proof that the child is not older than 18 years
  • Copy of a valid passports & visa for both passengers, if travel originates outside the U.S.
  • Proof of legal guardianship of the person accompanying the child. There may be additional legal documentation required that may apply to this trip. It is the sole responsibility of accompanying adult to provide this documentation.

Financial Verification Requirements

  • Letter of recommendation from a social worker at a medical facility, or from a non-profit organization dated (within 60 days of travel) and signed:
    • If from a social worker, proof of employment and occupation at a medical facility is required.
    • If from a non-profit organization, official government certificate of status required.

Medical Requirements

  • Typed letter (on letterhead) from a local physician, dated (within 60 days of travel) and signed by the physician, containing the following information:
    • Statement specifically documenting the necessity for medical treatment at a U.S. facility.
    • Include child’s name, date of birth, and medical background.
    • Information about the child’s current medical condition.
    • A statement that the child is medically stable and able to use air transportation.
    • Identification of special needs or assistance required during the flights. (Note: If oxygen is required, it is the responsibility of the passenger to purchase FAA approved portable oxygen concentrator.)
    • The name of the hospital/facility to which the child is traveling.
    • The name of the physician that is overseeing the treatment.
  • Typed letter (on letterhead) of confirmed appointment with a U.S. physician or hospital where the treatment is to take place, dated (within 60 days of travel) and signed by the physician.
By clicking submit, I attest that the information provided in this application is true and accurate to the best of my knowledge and belief. 

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