Dream Request Application

The James Bess Foundation is a national nonprofit organization that grants a wish to adults (21-65) battling a terminal illness.  Our goal is to encourage people to search within themselves and uncover dreams that have become lost due to life’s difficulties and then grant such dream to the best of our ability.
 
It is time for adults to dust away the cobwebs of life and start dreaming again!

WISH ELIGIBILITY REQUIREMENTS

• Be between the ages of 21-65.
• Live in the United States of America.
• Have a diagnosed life expectancy of 18 months or less.
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WISH APPLICATION GUIDELINES

• Please read this form very carefully and follow all the instructions to complete the steps necessary to make your wish come true.
• You will find many answers to your questions in our Frequently Asked Questions section.
• Please submit all required information; incomplete applications will be denied.

WE DO NOT FULFILL CERTAIN TYPES OF WISHES:

• Requests for adults with chronic illnesses – with the exception of individuals with a clinical prognosis of 18 months or less
• Requests from individuals living outside the USA.
• Surprise Dreams
• Legal assistance
• Cruises
• Cash/Financial assistance
• Reimbursements
• Funeral arrangements or posthumous requests
• Automobiles, Lifts, Repairs, RVs or Rentals
• Travel outside of the U.S. On a case-by-case basis we may allow one-way travel outside of the U.S. and Puerto Rico for patients who wish to die at home
• Property, home improvements, repairs or housing assistance
• Medical treatment/supplies/equipment/transport
• Any Dream request in violation of the rules, policies or procedures of our organization or that of our corporate partners, in effect from time to time

The Wish Application can be completed online or mailed to:
James Bess Foundation
9006 Brixworth Ct.
Old Hickory, TN 37138

We suggest you print the entire application here for reference before completing the online form.

We cannot process any incomplete applications.  Please read our FAQ’s and the above information before completing the application. If you don’t file taxes, you can provide other proof of annual income (e.g. supplemental security income (SSI), disability statement or bank statement).

WISH APPLICATION
Please use the following links to fully complete your application:
1. Apply Online OR Download Hardcopy Application
2. Download HIPAA Form and attach to online application or mail with hardcopy application
3. Download Medical Release Form and have your doctor fill out and either email or mail it into us separately
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Questions about your application? 
Please contact [email protected] or call 615-679-8001