Medical Funding Grant | HADDS Foundation

EBF3 HADDS Medical Funding Program

Individuals diagnosed with EBF3-related HADDS often require ongoing specialized care; which can include but is not limited to medical appointments, testing, therapies, hospital stays (and living accommodations for families during hospital stays) as well as expensive equipment and/or devices. This can place a significant burden on families and caretakers. To help ease this burden, the EBF3 HADDS Foundation has established the EBF3 HADDS Medical Funding Program to provide medical financial relief to individuals living with HADDS.

If you have questions or would like assistance with this application, please contact info@hadds.org.

Application Process:

Applications are processed and reviewed by the EBF3 HADDS Foundation Board of Directors in the order they are received. Approvals can take up to 4-6 weeks. If you have an urgent matter, please email info@hadds.org before starting the application process.
Incomplete applications will be returned and not reviewed.
If approved, a check will be issued to the medical vendor or applicant/designate not to exceed $1000 USD.
Applicants will be notified by email of the board’s decision.
Approvals are valid for 6 months unless an extension is requested.

Please Note: Approval is not guaranteed and the Board reserves the right to require additional documentation, which may include invoices and receipts from the medical vendor. Annual funding for this program is limited and once funding is exhausted, the application process will close until funding is renewed.

Requirements:

Individuals applying for funding must have an EBF3 HADDS diagnosis as verified by a statement of diagnosis.
If the purchase has already been completed, receipts in full must be provided for all services and (or) equipment. Payment will be made directly to the applicant/caretaker.
If the purchase has not been completed, the expected invoice amount must be provided by the vendor on vendor letterhead for all services and (or) equipment. Payment will be made directly to the vendor.
Applications must be accompanied by a letter of support written and signed by a professional
(Doctor, Therapist, Social Worker, Specialized Doctor, etc.) stating the need for equipment and (or) service.

Please note: An applicant, can only submit one application per year.

Medical Funding Grant Application

Applicant First Name

Applicant Last Name

Mailing Address (street, city, state/province, postal code, country)

Home Phone

Mobile Phone

Birthday (of Individual living with HADDS)

Name of Indiviual Submitting Application (N/A if submitting for self)

Relationship to Applicant (N/A if submitting for self)

Name of Individual/Vendor to Receice the Check

Address of Invividual/Vendor to Receiving the Check

Amount of Funding Being Requested

If this is for a procedure or appointment; what is the date of the event?

Type of equipment, service(s), and/or item(s) required:

Has the equipment, service(s), program(s), and/or item(s) been purchased and paid for?

Are you receiving any additional assistance in the form of a grant from another non-profit or private party (other than insurance)?

Anything additional we should know before making our decision?

By signing this application, I confirm that the information submitted in this application is accurate and if approved, all funding will be used for the services and (or) equipment as stated in the application.

Thanks for completing the Medical Funding Grant Application. Please expect to hear from us within 4-6 weeks.