Footwear Fund

We recognize the expense and limited selection of options for our members so this fund was established to assist our members ages 2 and up. This reimbursement fund, thanks to private donations and Dr. Scholl Foundation, contributes up to $75.00 to our members towards your purchase of shoes, boots, socks, adaptive footwear, specialty footwear. Reimbursement can be requested for up to $75.00 per calendar year by completing this form and submitting via email proof of purchase/payment.

Name of person with SB

First Name

Last Name

Date of birth

Name of person 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 your reside in

Describe the footwear item(s) you purchased and how they meet the needs of the person with spina bifida.

Please include brand name and where you purchased the item. This may help others find footwear that meets their needs. Footwear does NOT have to be special or adaptive.

Checkbox

I understand my request is not complete until I email my receipt / proof of purchase to sbwis@sbwis.org (receipt showing payment).

I understand that I can submit more than one request to be reimbursed up to the $75 cap per calendar year.

If I choose to send a photo, I give permission to SBWIS to use this photo on social media with my first name to promote this service to our followers.

How do you keep in touch with SBWIS?

Checking the website

Following Facebook posts

Email blasts

Submit for Footwear Fund

Footwear Fund