2025 LADN Grant Application

The LADN Grant Program was created to help ease the financial burdens of dysautonomia patients living in LA and California. Our grants help cover dysautonomia-related healthcare expenses (not covered by insurance) for dysautonomia patients in California who demonstrate financial need. 

We anticipate awarding a total of 12 individuals with grants of $1,000 in 2025. Applications open at 12:00am PST on Monday, September 1st, 2025 and close at 11:59pm on Monday, October 13th, 2025 PST. 

 

ELIGIBILITY:

Any individual who meets the following eligibility criteria may apply:

• Has a dysautonomia diagnosis by a licensed healthcare professional.

• Resides in California (with at least 50% of grants awarded to residents of Los Angeles County).
  

• Demonstrates financial need, as defined as annual household income at or below 425% of the Federal Poverty Level (FPL). (This number can be found on line 11 of Form 1040 on your 2024 tax return. A FPL calculator can be found here. Ex: 425% of the 2024 FPL for a household of 1 = $64,005; 2 = $86,870; and 3 = $109,735 etc.) Note: If the applicant is a dependent, then these income requirements apply to the individual(s) claiming them as a dependent. If you are an adult disabled dependent and do not meet the eligibility criteria based on the tax information of the individual(s) claiming you, we encourage you to apply and ask that you explain your circumstance in the optional essay.

• Has documentation of dysautonomia care-related expense(s).

• Participation in the LADN community is not a requirement, but preference may be given to those that are active LADN community members.

• Previous applicants are welcome to apply again. Previous grant winners are encouraged to reapply, however, priority may be given to those who have not received funding previously.

Don’t meet the eligibility criteria but feel like you should be considered? Please email us at LADN@la-dn.org!

 

CONFIDENTIALITY:

LADN takes your privacy very seriously. This application is stored on Jotform's HIPPA compliant servers. LADN staff are the only people with access to the full applications and will redact identifying information before sharing applications with grant selection committee members. Your name will not be shared as a winner unless you choose to make such information public.

LADN will take reasonable steps to protect your personal information but shall not be held responsible for unintended disclosures outside of LADN’s reasonable control.

 

GRANT SELECTION CRITERIA:

Applicants that meet the eligibility criteria and fully complete their application will have their applications evaluated by LADN's Grant Selection Committee. Personal information will be redacted for the grant selection committee's review process (with the excpetion of LADN staff members). Recipients of the 2025 LADN grants will be chosen through a process using this rubric and that evaluates the following areas:

 

• Dysautonomia Impact: Applicant articulates their experience with dysautonomia and the impact dysautonomia has had on their life.
• Need for Support: Applicant demonstrates an exceptionally compelling need for support.
• Dysautonomia Care Plan: Applicant identifies how the grant award will directly support their dysautonomia care.
• Spending Plan: Applicant provides clear and detailed explanation for how the grant award will be spent (including documentation).

 

For final selections of grant recipients, preference may be given to those that are active members of the LADN community. Additionally, at least 50% of grant funds will go to residents of Los Angeles county with the remainder going to residents across the state of California.

 

LADN is committed to inclusivity and diversity and will not discriminate on the basis of race, color, religion, sex, gender identity or expression, age, disability, sexual orientation, national origin, comorbid illnesses, political affiliation, immigration status, or intersectionalities of identity.

 

ELIGIBLE HEALTHCARE EXPENSES:

Grants can be used toward any dysautonomia healthcare related expenses that are not covered by insurance including but not limited to:

• acupuncture
• copays
• health insurance premiums
• infusion expenses
• inpatient/outpatient medical treatment
• laboratory facility expenses
• mobility aids or other assistive devices
• naturopathy
• nutrition
• prescription costs
• psychotherapy
• PT / OT / cardiac rehab

Ineligible expenses: General food expenses (excluding supplements, electrolytes, medically-directed nutrition, etc.), rent, general automobile expenses (excluding direct travel costs to/from medical appointments), and other expenses not directly related to medical treatment are not eligible. Please email us at LADN@LA-DN.org to inquire if a specific expense is eligible.

 

APPLICATION DEADLINE:

All application materials must be submitted by 11:59pm on Monday, October 13th, 2025 PST. Applications may close early if we reach our limit of 100 applicants.

 

NOTIFICATION OF GRANT AWARDS:

All 2025 LADN grant applicants will be notified whether they are a recipient by December 6th, 2025. 

 

QUESTIONS??

Join us for a workshop on how to apply on Wednesday, September 17th at 1pm PST. Last year's workshop is available to view here, however there have been some changes to the application.

Have last minute questions? Get help during our closing office hours on Friday, October 10th from 12-1pm PST.

Please email us at LADN@la-dn.org with any further questions.

 

HELPFUL REMINDERS:

1.) Please ensure that you complete the entire application.

2.) You may have someone submit an application on your behalf if your illness/disability prevents you from being able to submit an application yourself.

3.) You may save your application by clicking "save" at the bottom of the application page. After clicking "save" you will receive an email from JotForm with a link to continue working on your application later. If you close your browser without saving your application first, your information will be lost.

4.) Supplemental documentation required with this application should be uploaded as PDFs or JPEGs. These include:

• California Residency Documentation
• Dysautonomia Diagnosis Certification
• Page 1 of Form 1040
• Dysautonomia Healthcare Expense Documentation
  
• (if applicable) Documentation of 2025 Income Change

5.) Carefully review the application for accuracy before it is submitted.

6.) The following questions have a 400 word maximum:

• Question 1: How has living with dysautonomia impacted your life? Please use specific examples (such as changes in health, ability level, life goals, career, social life, finances, etc.).
  
• Question 2: Why are you applying for a LADN Grant? Please describe any resources and help you currently utilize, the overall costs of and your need for financial support in your dysautonomia care, and how this grant would fit into your care plan.
  
• Question 3: Please describe the impact $1,000 would have on your dysautonomia healthcare. You will be asked to fill out a spending plan table below. There will also be space to provide documentation of expenses in the following section.
  

7.) A confirmation email will be sent to you following your grant application submission.

8.) Contact LADN at LADN@la-dn.org if you have questions or need technical assistance.

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Applicant Information:

If you are applying on behalf of someone, please enter their information below. You will have a chance to provide your information later.

California Residency Documentation:

Demographic Information: (Note: This information will be redacted during the LADN Grant Selection Committee's application evaluation process.)

Dysautonomia Diagnosis:

Please upload a completed Dysautonomia Diagnosis Certificate Form. Access the form here. *Form must be signed and dated by a licensed healthcare professional (physician, physician assistant, nurse practitioner, or registered nurse).* If you submitted this form previously (i.e. 2023 or 2024), you may use the same form.

Financial Information:

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ESSAY QUESTIONS:

Healthcare Expense Sheet

Please fill out this spending plan to demonstrate how you would spend $1,000 of grant money on dysautonomia-related healthcare expenses (both expenses from the past year and projected expenses are eligible). There will be a space to provide documentation of expenses in the following section. Please add up the total costs in the final column (with the last item you list, bringing the total cost to about $1,000). Please view an example here (please note these numbers are made up).

OPTIONAL ESSAY:

LADN Participation:

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APPLICANT CERTIFICATION:

I certify that the information in this application is true and correct. I understand that falsification of any information will result in disqualification of this application. I agree that this application becomes the property of Los Angeles Dysautonomia Network and will be reviewed by the grant selection committee. I understand that this application will be assessed based on the information provided and submission of it does not guarantee that I will receive a grant award. I acknowledge that LADN will take reasonable steps to protect my personal information but agree that LADN shall not be held responsible for unintended disclosures outside of LADN’s reasonable control. I agree that in the event I am a grant recipient, I may be required to provide relevant tax documentation/information, and I understand that grant awards may be considered taxable income. 

 

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