Application Forms

New Jersey State Organization of Cystic Fibrosis

Pharmaceutical Services for Adults with Cystic Fibrosis

Program Requirements:

  1. DIAGNOSIS OF CYSTIC FIBROSIS VERIFIED BY CF DOCTOR.
  2. MUST BE A NEW JERSEY RESIDENT.
  3. MUST BE 18 YEARS OR OLDER.
  4. INDIVIDUAL ANNUAL INCOME LESS THAN $45,156/YEAR.

Complete the application and return it with all required documents to:

NJSO Cystic Fibrosis
PO Box 3648
Wayne, NJ 07474-3648


Phone: 973-595-1232
Fax: 973-595-1718

The documents needed to process your application are:

  • Completed “Application”.
    • Copy of your NJ Driver’s License AND Birth Certificate.
  • Completed, signed and notarized “Insurance Affidavit”.
    • Copies of all current Health Insurance Cards.
  • Signed and notarized “Income and Acceptance Affidavit”.
    • Copy of your 2011 Federal Tax Return with all W2’s, 1099’s and/or your SSI Benefits Statement.
  • Signed “Signature Form” for Pathmark, A&P or Wegmans.
  • Signed “Patient Authorization for Health Information Disclosure” (HIPPA compliant)

Failure to submit ALL of the above items will delay your acceptance into the Program.

How to get the forms:

The required applications and forms are in PDF format. To view and print them in their true format you need Adobe®Reader®.If you don’t have it you can download it for free.Download Adobe Acrobat Reader

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Up Coming Events

Saturday, April 27th
Eleveth Annual Sunset Bowl, T-Bowl II Lanes, Wayne, New Jersey

May 2013
Mother’s Day “Make Believe” Tea Party

Friday, August 2nd
30th Annual Golf Tournament, Wild Turkey Golf Course and Ballyowen Golf Course,
Awards Dinner held at Crystal Springs Country Club, Hardyston, New Jersey

Thursday, October 10th
37th Annual Fall Dinner, Westmount Country Club, Woodland Park, New Jersey

November 16th, 2013
Bowl for CF Awareness, Bowl-O-Drome, North Arlington, New Jersey
click link below to download registration form
CF 2013 Bowl – 4 – Awareness


mission

Do you have Cystic Fibrosis or
know someone who does?

WHO WE ARE: The New Jersey State Organization of Cystic Fibrosis was founded in 1977 to provide direct, “hands on” financial assistance to cystic fibrosis patients throughout the state. NJSOCF also provides counseling, referrals and educational materials to patients and their families.

NJSOCF is a not-for-profit organization that uses its donated dollars to purchase the daily necessities of living for patients with the disease. These include prescription drugs, medical equipment, nutritional supplements and extra nutritious foods. Services are available to patients from birth to adulthood. Adult patients receive services through a special state-funded program specifically for adults with cystic fibrosis.


2013 BOWL * 4 * Cystic Fibrosis Awareness

As most know, I always give, always try to help and never ask for anything except for this one time of year when I run this event. If you can’t make it but are willing to donate, that would be appreciated by myself and more so by those we help.

Did you know ?

1. Life expectancy 37-40 yrs
2. issues with gaining / maintaining weight
3. 2-3 hrs of treatments daily that include nebulizers and therapy vests
4. must take medication for their entire life

My Goal in addition to raising awareness of this deadly disease is to raise money for those who need assistance with medications, nutritional supplements and medical equipment so they can manage their health and try to enjoy life.

The Bowling alley has 32 lanes X 6 bowlers per lane. I would like to fill each lane this year.

$ 35.00 per person or choose a sponsor package on registration form.

*** The night will include (3) games of bowling Scotch Doubles- 3 couples pairing up – 1st bowler throws 1 ball, then 2nd person throws 2nd ball on same frame ***
Click the link to download the registration form.
CF 2013 Bowl – 4 – Awareness

Call / email or text : 201-954-6144 / gmcdermott_1@verizon.net