CJB ORGAN TRANSPLANT ASSISTANCE PROGRAM

OTAP's Mission

After Cody’s tragic passing, a number of close friends and family established the Cody Barrasse Memorial Foundation. The goal of the Foundation is not only to carry on the legacy Cody left behind, but also to promote organ donor awareness and provide service to those awaiting transplantation. As part of the foundation’s mission, OTAP helps to defray the cost of those awaiting transplantation in Lackawanna County.

Download Official Brochure

OTAP Application Form

Before you begin filling out our form, please read the complete list of instructions!

Ensure that you are on the the national transplant waiting list*.
Next, choose “self” or “other” above the contact form.
Complete the form, and hit submit.
Our team will review your information, and contact you in the coming weeks!

If you are unsure of your waiting list status, please contact your primary care physician

Who is Applying? Choose “Self” or “Other”.

Self
Other

Name *

Title *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

What is your diagnosis? *

What organ are you waiting for? *

What do you expect to need other than funding for medical expenses, food, transportation, lodging, or child care services? *

Physician *

Referring Physician Office Phone Number *

We are interested in learning more about you. Please tell us your story. (In (x) characters or less, tell us why you should receive this grant?) *

How would you like to be contacted by our team? *

How Did You Hear About Our Program?

Website

Applicant's First & Last Name *

Your Title *

Applicant Address *

Address Line 1

Address Line 2

City

State

Zip Code

Applicant's Phone *

Applicant's Email *

Patient's First & Last Name *

Patient's Date of Birth *

Patient's Address *

Address Line 1

Address Line 2

City

State

Zip Code

What is patient's diagnosis? *

What organ is patient waiting for? *

What do you expect to need other than funding for medical expenses, food, transportation, lodging, or child care services? *

Physician *

Referring Physician Office Phone Number *

We are interested in learning more about you and the patient. Please tell us your story. (In (x) characters or less, tell us why you should receive this grant?) *

How would you like to be contacted? *

How Did You Hear About Our Program?

What Relation Do You Have with the Patient? *

Comment

In submitting our form, you agree to be contacted by the Cody Barrasse Memorial Foundation through which ever preferred method previously specified.

OTAP In the Press

The Cody Barrasse Foundation launched OTAP on Cody's Birthday, February 9, 2018. Since then, we've seen our program generate quite a bit of attention in our area. Check out foundation president, Joe Barrasse, discuss OTAP with Newswatch 16.

Newswatch 16 Feature