Application

If you would like to be considered as a beneficiary of the Pretty Sweet Foundation, please fill out the form below:

Name

First Name

Last Name

Phone

(###)

###

####

Are You Type 1 Diabetic?

Do You Live In Utah?

Age Group

for car rental & insurance reasons

Do You Have a Valid Passport?

Do You Have a Valid Drivers License?

Do You Currently Have Health Insurance?

Are You the Beneficiary of Any Other Financial Assistance for Your Diabetes?

Government or Private Assistance

Are You Comfortable Traveling via Airplane?

Tell us a little about yourself:

Is there anything you'd like us to know or take into consideration?

Estimated Monthly Cost of Insulin:

$ Please do not include cost of pumps or CGM's

Yearly Household Income:

$ Estimate

Is This You First Time Applying?

An application does not guarantee assistance from the Pretty Sweet Foundation. All applicants are considered by our board members. Decisions are based on ease of access to insulin from the questions above through our Insulin Trip program. Additional information may/will be needed. Decisions ARE NOT based on the applicant’s personal information, relations, appearances, abilities, or orientations. At this time, we can only consider Utah residents.

-The Pretty Sweet Foundation

Application

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