CARES Act Grant Application

MILESTONE MILES 2025 RECIPIENT APPLICATION

DEADLINE: August 15, 2025

THE STONE FOUNDATION: Our mission is to advocate for and raise awareness about the needs of individuals living with physical limitations and/or mental health challenges, helping them achieve meaningful life milestones. Milestone Miles 2025 is our second annual community event, dedicated to raising funds so that individuals in our community can access adaptive medical equipment and assistive technology that enhance daily functioning and overall quality of life. These essential tools are often expensive and not always covered by insurance, even when medically necessary. Through Milestone Miles, we aim to ease the financial burden on individuals and families by providing direct financial support for the purchase of this vital equipment.

EVENT DESCRIPTION: Milestone Miles is a team-based stationary bike race designed to bring the community together for a meaningful cause. The event features 15 teams, each made up of 5 members, with participants taking turns riding in 20-minute intervals over the course of 2.5 hours. The team that racks up the most total miles will be crowned the winner!

Each team is encouraged to raise a minimum of $500 to participate, with 100% of the proceeds going directly to support individuals in need of adaptive medical equipment and assistive technology.

The second annual Milestone Miles will take place on October 4, 2025, at the Williston ARC.

APPLICATION QUALIFICATIONS:
- Must live in Williams County with proof of address
- Individuals of all ages with permanent disabilities that affects them physically or mentally
- Exhausted funding options from commercial insurance or state funded insurance (Medicaid) with proof of denial (if applicable)
- Funding will be provided for the following expenses within 60 days from the time of the event which takes place on October 5, 2024
  - Medical equipment
  - Assistive technology
  - Home modifications
  - Vehicle Modifications
  - Service Animals
  - Travel Expenses for medical treatment
- Meets the financial requirements
  - 700% of the 2024 federal poverty level with proof of most recent tax return *guideline attached
- Follow up may be needed as your application is being reviewed by the Milestone Miles Committee
- If you/your child is chosen as a recipient of Milestone Miles funds, it is strongly encouraged to be present at the event

1. Online Application
Applicant Name*

First NameLast Name
Parent/Guardian Name (If under 18 years old)

First NameLast Name
Applicant Date of Birth*

MonthDayYear
Date
Applicant Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Applicant Medical Diagnosis: *
ex: cerebral palsy, stroke, autism
Brief description of what you are requesting funds for?*
ex: wheelchair, safety bed, travel reimbursement, communication device
Financial Amount Requested*
ex: $1,000
I grant The Stone Foundation the right to share my/my child's photograph as well as any videos and interviews taken to help showcase my/my child's story if chosen as a recipient of funds on social media platforms, The Stone website and at the Milestone Miles event.
Signature*

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Technical Assistance
Should you have technical questions regarding the online submission process, please contact us at (701) 651-6437

2. Impact statement
Please describe your story and reason for request in detail. Please be as thorough as possible. (1,500 word maximum)*

0/1500
2024 Tax Return for proof of financial eligbility*

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Proof of address *

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Insurance denial (if applicable)

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Invoices/Quotes (if applicable)

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To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form from the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

Technical Assistance
Should you have technical questions regarding the online submission process, please contact us at (701) 651-6437
3. Submit Application
*

I certify that the information I have provided is truthful and complete to the best of my knowledge
Signature*

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Date*
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1. Online Application

2. Impact statement

3. Submit Application