2025 Kel Strong Scholarship Application

2025 'Kel Strong' Mabatah Foundation Scholarship Application

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Financial assistance may be provided to qualifying individuals through the ‘Kel Strong’ Scholarship. This is a donor funded scholarship operated by Memorial Hermann Health System. Individuals may receive 13 therapy sessions (evaluation + 12 treatment sessions) of one therapy discipline (i.e. PT, OT, or SLP) at TIRR Memorial Hermann or receive assistance towards out-of-pocket costs for a maximum of $8,000. The review panel consists of TIRR Memorial Hermann Kirby Glen director and/or rehab manager and therapists/fitness trainers.

Eligibility Criteria:
1. Annual household income < $100,000
2. Have a diagnosis of Traumatic Brain Injury (TBI), Encephalitis or Encephalopathy
3. Unfunded, underfunded, or unable to afford out-of-pocket costs for recommended skilled therapy sessions
4. Must have reliable transportation to get to and from therapy
Criteria for finalists will be highlighted by the following:
- Work Ethic
- Need-based funding
- Goals and expectations moving forward
Documentation required to verify eligibility:
1. Picture ID
2. Reference letter from current or past therapist or social worker
3. Most recent household tax return (redact social security numbers)
4. If not working, a notarized affidavit stating sources of support
5. Proof of residence - last two (2) utility bills
SUBMISSION DEADLINE TUESDAY, SEPTEMBER 30, 2025 AT 5:00 P.M.
Name*

First NameLast Name
PHONE*
EMAIL*
example@example.com
PREFERRED METHOD OF CONTACT:*

EMAILPHONE
PLEASE LIST DATE (MM/DD/YR) OF YOUR TBI/Encephalitis/Encephalopathy*

MonthDayYear
Date
PLEASE DESCRIBE WHAT CURRENT THERAPY (BOTH CLINICAL AND PERSONAL) YOU ARE ACTIVELY PARTICIPATING IN*
HOW MANY SESSIONS PER WEEK DO WE REQUIRE:*
PLEASE RANK (WITH 1 BEING THE HIGHEST AND 3 BEING THE LOWEST) THE TYPE OF THERAPY THIS SCHOLARSHIP WILL BE UTILIZED FOR. THE 13 SESSIONS MUST BE UTILIZED FOR ONE THERAPY DISCIPLINE:
-Physical Therapy. Enter 1 thru 3*
-Occupational Therapy Enter 1 thru 3
-Speech-Language Therapy Enter 1 thru 3*
PLEASE TELL US WHY YOU BELIEVE YOU DESERVE THIS SCHOLARSHIP:*
WHAT ARE THE OUT-OF-POCKET COSTS FOR THE RECOMMENDED THERAPY? (EXAMPLE $40 CO-PAY PER SESSION OR $400 DEDUCTIBLE)*
Picture ID*

Cancelof
Most Recent Tax Return (REDACT SSN). If not working, a notarized affidavit stating sources of support.*

Cancelof
Reference Letter From Current or Past Therapist or Social Worker*

Cancelof
Proof of Residence - Utility Bill #1*

Cancelof
Proof of Residence - Utility Bill #2*

Cancelof
Signature*

Clear
DATE*

MonthDayYear
Date
Thank you for taking time to apply for the ‘Kel Strong’ Scholarship. Please do not forget to attach the recommendation from your therapist/social worker to this application. If you have questions, please submit them to: TIRRMHOPTherapyScholarship@memorialhermann.org
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2025 'Kel Strong' Mabatah Foundation Scholarship Application