Family Assistance Program • NICU Helping Hands

The hospitalization of a baby in the NICU can leave a family financially unprepared. If you are a current NICU family experiencing financial difficulty we may be able to assist you through our gift card program. NICU Helping Hands’ gift card program provides assistance with grocery, restaurant, and gas expenses.

Please note you must give consent for your social worker to speak with NICU Helping Hands for verification purposes.

*If you are interested in donating a wedding gown to assist the Angel Gown® program, please review the Wedding Gown Donation FAQs.
Name*
First Last
Email*
Phone*
I am a...*
- Parent/Family Member
- Current resident of the DFW metroplex area and would like to volunteer
- Hospital
Address*
Street Address Apartment Information City State ZIP Code
I am interested in being a NICU Helping Hands volunteer. Please contact me about volunteering for the following programs:
- Project NICU (DFW Metroplex Only)
- Administrative Assistance (DFW Metroplex Only)
- I am a local (DFW Metroplex) business owner and would like to discuss ways to help
I would be willing to help with data entry and shipment verification.
This requires your physical presence at our Bowie Blvd warehouse location.
- Yes, I am available during the weekday
- Yes, I am available in the weekday evening
- Yes, but I am only available on the weekends
Thank you for your interest in becoming a member of our team of volunteer seamstresses with our nationally trademarked ANGEL GOWN® PROGRAM. At this time we are not accepting seamstress applications.
To be notified when our application process will reopen, please subscribe to our newsletter newsletter
I am available:
Choose all that apply.
- Weekdays between 8am-12pm
- Weekdays between 12pm-4pm
- Saturdays 8am-12pm
- Saturdays 12pm-4pm
- Other
Volunteer Availability Notes:*
I am requesting:*
- Financial Assistance
- One-on-One Mentoring
- An Urgent Angel Gown
The hospitalization of a baby in the NICU can leave a family financially unprepared. If you are a current NICU family experiencing financial difficulty we may be able to assist you through our gift card program. Please let us know what type of assistance you need. Someone on our staff will contact you as soon as possible.
Hospital Name*
Contact Name & Title*
Contact Phone*
Contact Email*
Hospital Address*
Street Address Address Line 2 City State ZIP Code
Social Worker Name*
Social Worker Email*
Social Worker Phone*
Our hospital is requesting:*
- Information on Project NICU
- Angel Gown® Garments
How many infant losses do you have in your hospital annually?*
Please include all loss so that we can determine number of gowns you will need on an annual basis (e.g. fetal demise, stillborn, pre-viable, NICU losses, lethal congenital anomalies, etc).
Does your hospital have both L&D and a NICU?
- Yes, both L&D and a NICU.
- L&D only.
- NICU only.
- Neither L&D or a NICU.
Additional Information
We are saddened that anyone needs an Angel Gown®, but we are honored to provide your precious child with a garment that has been lovingly made by a volunteer seamstress from a donated wedding gown.

If you are requesting a garment on behalf of a friend or family member who has lost their child please be sure to confirm all information related to the gestation/age and weight of the baby. Please insure the accuracy of the shipping address you are providing before filling out this form.
- Urgent requests are processed by 3pm Monday-Friday.
- Requests received after 3pm will be processed the next business day.
- Requests received before 3pm Monday – Friday will be shipped in the afternoon via two day FedEx.
- Requests received before 3pm on Thursday will arrive via two day FedEx on the following Monday.
- Requests received before 3pm on Friday will arrive via two day FedEx on the following Tuesday.
- Requests received on Saturday and Sunday will be processed on Monday.
The cost of shipping an Angel Gown® garment via two day FedEx is currently provided by NICU Helping Hands through generous donations from families, friends and other supporters. We are unable to cover the cost related to overnight shipping, however families requesting overnight service will be provided pricing and payment options to cover this service when needed. Thank you for your understanding.
Baby's Weight*
Our garments and wraps are made for babies weighing only ounces up to 10 lbs. We do not have garments for babies over 10 lbs.
The gestational age of the baby at the time death was*
If the baby was born before 40 weeks gestation please list the exact gestation of the baby (e.g. 24 weeks). If the baby was full term please list that as well (40 weeks).
Hospital Where Baby Passed Away*
Family Name (If different from the person submitting this form.)
This gown is needed for a baby*
Date of Funeral Service*
It is very important that you give us an exact date for the service so we know exactly when the gown is needed. The date of the funeral service lets us know exactly when the garment is needed for the service. We will not ship a garment without this information. Format: MM/DD/YYYY
MM slash DD slash YYYY
Shipping Address*
Do not list a hospital shipping address. Delivery can be delayed when items are shipped to hospitals. The best place for us to quickly ship a garment is to a home address or funeral home.

Street Address Address Line 2 City State ZIP Code
Shipping Options*
- Two day shipping via FedEx provided at no charge.
- Overnight shipping via FedEx. The cost of shipping an Angel Gown® garment via two day FedEx is currently provided by NICU Helping Hands through generous donations from families, friends and other supporters. We are unable to cover the cost related to overnight shipping, however families requesting overnight service will be provided pricing and payment options to cover this service when needed. Thank you for your understanding.
Your Mailing Address*
Street Address City State ZIP Code
Hospital
- Baylor All Saints
- Cook Children’s
- Harris Methodist Downtown
Preferred Method for Mentor to Contact You:*
- Phone
- Email
- Other
Which best describes your need for a mentor?*
- I have experienced the loss of a child
- I currently have a child in the NICU
- My child has been discharged from the NICU
Gift Card Request:
- Gasoline
- Grocery
- Restaurant
NICU Baby Information
Baby's Name(s):
Gestational Age(s):
Birth Date(s):
General Overview: (diagnosis info, length of stay, special needs, family challenges, etc)*
Do you have older children?
Older Children
How many older children do you have?*
Child 1: Name*
Child 1: Age*
Child 1: NICU Stay?*
Child 1: NICU Info (Gestational Age, Weight, etc) if applicable:*
Child 2: Name*
Child 2: Age*
Child 2: NICU Stay?*
Child 2: NICU Info (Gestational Age, Weight, etc) if applicable:*
Child 3: Name*
Child 3: Age*
Child 3: NICU Stay?*
Child 3: NICU Info (Gestational Age, Weight, etc) if applicable:*
Additional Children*
Please enter their names, ages and NICU information if applicable.
Baby Information
Gestational age of your child at the time of loss
Please feel free to share any relevant information that will help us select an appropriate mentor for you (ex. miscarriage, prenatal loss, diagnosis, cause of death, etc.):
Was this a multiple or singleton pregnancy?
- Multiple
- Singleton
Did you experience a single loss or multiple loss?
- Single loss
- Multiple loss
Are there surviving siblings from this pregnancy?
- Yes
- No
Do you have any older children?
NICU Baby Information
Baby's Name(s):
Gestational Age(s):
General Overview: (diagnosis info, length of stay, special needs, family challenges, etc)*
How many older children do you have?*
Birth Date(s):
Child 1: Name*
Child 1: Age*
Child 1: NICU Stay?*
Child 1: NICU Info (Gestational Age, Weight, etc) if applicable:*
Child 2: Name
Child 2: Age
Child 2: NICU Stay?*
Child 2: NICU Info (Gestational Age, Weight, etc) if applicable:*
Child 3: Name
Child 3: Age
Child 3: NICU Stay?*
Child 3: NICU Info (Gestational Age, Weight, etc) if applicable:*
How may we help?*
Name
This field is for validation purposes and should be left unchanged.

NICU Baby Information

Older Children

Baby Information

NICU Baby Information