Support Fund

Purpose of the Fund: The Support Fund is designed to assist persons with spina bifida and/or hydrocephalus with the cost of adapted equipment, medical equipment, services such as adapted lessons or camps and emergency personal expenses directly resulting from the fact that the person has spina bifida and/or hydrocephalus.

This fund does not cover expenses which would be covered by Alberta Aids to Daily Living (AADL), Family Supports for Children with Disabilities (FSCD), private / public medical insurance, Assured Income for the Severely Handicapped (AISH), or any other government programs The support fund only covers expenses which are required because the applicant has spina bifida and / or hydrocephalus and requests outside of this nature will not be considered.

Applications will be considered at the meetings of the Board of Directors which occurs on the Third Wednesday of the month and Please be advised that there are no meetings in July, August or December. In the case of emergency services, a verbal application to the association can be made as long as it is followed up within 14 days with a written application. Funds may be advanced for emergency expenses at the discretion of the SBHANA Board Of Directors.

For 2023 the Support Fund will have a maximum of $1,500 per members allowed within the SBHANA fiscal year and/or maximum of $500 of the $1,500 per year will be paid for adapted sport and recreational programming.

The SBHANA Board of Directors have allocated a total of $20,000 per fiscal year for 2023. This total may change due to funding received. (Fiscal year is from February 1 to January 31.

The Support Fund application will be automatically sent to SBHANA. You are able to upload files onto this application or you send all accompanying paperwork (quotes, invoices, emergency receipts, copies of application for programs or services, and invoices for adapted recreation programming fees) to SBHANA Office Applications will be marked incomplete if quotes and invoices are not received at the SBHANA office.

There is NO retroactive funding for items and all requests must provide a quote and once purchased a receipt for the item.

Current Membership (membership must be current to apply for support)*

YesNo

Have you read the Funding Request Guidelines?*

YesNo

Name*

First NameLast Name

Name of Person with Spina Bifida and/or Hydrocephalus:

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

What kind of funding are you requesting??*

Adaptive Medical Supplies and EquipmentVehicle AdaptationHome ModificationsAdaptive Sport and Recreation Costs - note the Support Fund covers $500 of the $1,500 towards programming and all funds are payable to the organizationOther

Description of item:*

How will this equipment aid the person affected by spina bifida and/or hydrocephalus? (i.e. how it works, what it is used for, why/how would this equipment or technology be important to the individual affected by spina bifida and/or hydrocephalus ) **

Cost of Service or Item Required:*

Cost you are asking the SBHANA to pay:*

Do you have private insurance that will cover some or all of the cost for the equipment, service(s), program(s), and/or item(s)?*

YesNo

Have you approached any other agency for funding ? If yes, give details:*

Please use this space for any additional information and/or pertinent details you would like to provide.

Upload Receipts or Invoices:

Browse Files

Volunteer Support – a member claiming under the Support Fund are required to make a commitment of volunteer time to support the SBHANA where possible. Volunteer support for the SBHANA allows the organization to put on events that raises much needed funds to support programing such as Camp Freedom and the Support Fund. Please choose a volunteer opportunity from the list and a staff member will contact you regarding volunteering. The SBHANA has a variety of volunteer opportunities that you are able to volunteer for. Please click on an opportunity that interests you:*

Have you volunteered for the SBHANA in the last year? Please check off the volunteering that you have done for SBHANA.

I here by certify that all the information contained in this application is, to the best of knowledge, accurate, true and complete in all respects. I understand that acceptance of this application and funding is under the complete discretion of the SBHANA Board of Directors. I also understand this application WILL BE DELAYED if it is to be founded incomplete in any respects. Signature

Clear

Date

SBHANA Support Fund Application