The traceBRAVE Foundation                                 Care Package Request 
The traceBRAVE Foundation provides care packages to children recently diagnosed (within the last 12 months) with Type 1 Diabetes, infant to age 21, or college students to age 24.  Please respond to each question as accurate as possible.  
 *must be 18 years of age and a U.S. resident* *please allow 7-10 days processing time*
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Email *
Name *
Name of child with Type 1 Diabetes *
Age of child with Type 1 Diabetes
 *
Gender of child with Type 1 Diabetes
 *
Complete mailing address *
Phone number *
Date of diagnosis  *
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How is your child's diabetes managed? 
Click all that apply
 *
Required
Please tell us a little about your child...interests, hobbies, favorite things etc. *We try our best to send something your child will enjoy so please be as specific as possible. *
Disclaimer

The traceBRAVE Foundation reserves the right to grant or deny any application of need at any time, for any reason, and to supplement or amend application information requests at any time, for any reason.  The traceBRAVE Foundation reserves the right to request proof of income from an applicant or parent/guardian of the applicant in need.  The traceBRAVE Foundation does not and shall not discriminate on the basis of race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, or military status in any of its activities, operations, or donations.  This includes but is not limited to the approval of an application for assistance with medical supplies, insulin, financial support, or food supplies.  The traceBRAVE Foundation shall maintain an applicant’s confidentiality and shall not share or supply an applicant’s information.
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