Family FUND ASSISTANCE

The Family Fund is established to help parents/guardians afford expenses related to caring for their child with Spina Bifida. Appropriate requests include assistance in paying for medical expenses, insurance copayments, incontinence products, shoes, over the counter medications and supplements. Requests can be made for $150.00 once per calendar year per child with Spina Bifida (birth to 17 years of age). Please fill out this form and click submit. Our staff will process your request and send you a check within 2 weeks.

Name of child with SB

First Name

Last Name

Date of birth

Name of person/place to make check out to

Parent or Legal Guardian, trust fund account or vendor/bank. All checks will be mailed to your home address.

First Name

Last Name

Home mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Wisconsin County you reside in

Family need:

Provide a brief description of what you'll use this money towards (must relate to needs of person with spina bifida)

Please share your suggestion(s) for additional ways SBWIS might support your family member with SB

We recognize your concerns about receiving this gift and the potential impact on SSI. Please provide the name of the person/business/organization the check should be made out to:

Provide the name of a trusted friend, credit card company, landlord, cable/mobile phone company or another third party. It is your responsibility to submit payment. Checks issued to a third party will not be reissued if lost.

How do you keep in touch with SBWIS?

Checking the website

Following Facebook posts

Email blasts

Submit for Family Fund

Family FUND ASSISTANCE