• IMMEDIATE IMPACT APPLICATION

    Through Immediate Impact, we foster resilience, ignite hope, and carve pathways to independence for individuals and families facing a significant, specific circumstance that creates an extraordinary burden on their lives and affects their ability to live safely, independently, and with dignity.

  • WAYS WE CAN HELP

    • Adaptive Equipment: wheelchairs, mobility scooters, hospital beds, and similar equipment not covered by insurance
    • Home accessibility modifications: ramps, chair lifts, bathroom modifications, and similar changes that allow someone to remain safely in their home
    • Urgent medical-related gaps: one-time costs tied directly to a disability or serious medical diagnosis that insurance and other programs do not cover
    • Tragic event: emergency support following a sudden catastrophic event that leaves a family in crisis

  • CIRCUMSTANCES THAT TYPICALLY DON'T QUALIFY

    • Medical: routine medical copays, deductibles, or equipment unrelated to a specific qualifying diagnosis or injury
    • Rent, Mortgage & Utilities: behind on rent because of reduced hours, or a layoff that is not connected to a medical, disability, injury, or disaster event
    • Employment & Income: difficulty finding a job, reduced hours, underemployment, or unemployment not tied to one of the qualifying circumstances

  • * The Garrett Family Foundation does not accept applications from outside the United States.

  • APPLICANT INFORMATION

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Are you applying for yourself or on behalf of someone else?*
  • Nominee Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Is the nominee aware they are being nominated?*
  • How did you hear about the Garrett Family Foundation?*

  • HOUSEHOLD

  • Does anyone besides the applicant live in the household?*
  • List additional household members.*

  • SHARE YOUR STORY

    This is the most important part of the application. Please focus on the specific event, circumstance, or need that has led you to seek assistance from the Garrett Family Foundation.
  • Which best describes the circumstance?*

  • HOW CAN THE GARRETT FAMILY FOUNDATION HELP?

  • Please provide a detailed breakdown of the amount requested. (Home modifications, adaptive equipment, or financial needs)*
  • Is there a specific deadline for this request?
     - -
    2 digit month, 2 digit day, 4 digit year

  • IMPACT ON EMPLOYMENT & INCOME

    This section helps us understand whether the circumstance described in the application affected the applicant's ability to work. Employment status alone is not a factor in eligibility — what matters is whether a specific circumstance is the direct cause.
  • Is the applicant employed?*
  • Has the circumstance described in this application prevented the applicant from working?*
  • Was the applicant or household already experiencing financial hardship before this circumstance occurred?*

  • OTHER RESOURCES

  • What are the applicant's other sources of income? (Select all that apply)*
  • Have you requested or received assistance from other nonprofit organizations, family or friends, community organizations, fundraising, or other sources?*

  • PREVIOUS GARRETT FAMILY FOUNDATION ASSISTANCE

  • Has the applicant previously received assistance from the Garrett Family Foundation?*

  • SUPPORTING DOCUMENTATION

  • Do you have supporting documents to support the current circumstance?*
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  • REFERENCE

    Please provide one individual who is familiar with the applicant's current circumstances and can speak to the situation described in this application.
  • Format: (000) 000-0000.

  • ADDITIONAL INFORMATION

  • APPLICANT CERTIFICATION

  • By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge. I understand that submitting an application does not guarantee assistance and that all requests are subject to review and approval by the Garrett Family Foundation Board of Directors. I understand that the Garrett Family Foundation may request additional information or documentation before making a decision. I understand that Immediate Impact is intended to provide assistance following a specific, significant circumstance and is not intended to provide general financial assistance or ongoing support for routine household expenses — including rent, mortgage, or utility payments that are not directly and currently tied to that circumstance.

  • Submission Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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