Family Application

Eligibility Requirements: To receive financial assistance from Miracle Travel Works, Inc. (MTW), families MUST be traveling for the purpose of seeking urgent medical treatment for their children’s serious ailments or injuries, age birth through 18 years old, and must have their main residence within the Midwest states, including North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa, Missouri, Arkansas, Wisconsin, Illinois, Michigan, Indiana, and Ohio. We will offer reimbursement for up to 3 months after the initial travel date, but by applying prior to travel you can help to ensure that money is reserved for your expenses in advance. You must provide itemized receipts to be refunded for travel expenses. Please feel free to email with any questions you may have when filling out the application.

Please thoroughly fill out each section, an incomplete application will result in delays.

If you already have an account and username with us, login here.

Password must be at least 7 characters long.

Primary Contact Parent Information

Child Information

Hospital Information

Additional Family Members

I accept
I accept
Upon receiving the donation, we require you to send a brief testimonial about your experience working with Miracle Travel Works and we would appreciate a picture of the child for use on our website or other marketing material. This will help us to encourage future donations and allow us to help additional families. Thank You, The Miracle Travel Works Board

Estimated Expense Information

Please estimate all applicable travel expense.

If you have additional expenses to add here, please provide a description of what they are for.