ALS Ice Bucket Challenge Progress


North Carolina Chapter Grant

The North Carolina Chapter Grant Program assists North Carolina families with expenses that are not traditionally covered by insurance such as private insurance, Medicare, Medicaid and other assistance programs. It will cover, but is not limited to, home care assistance (respite), travel costs related to ALS clinics or research, home modifications, auto modifications, communication devices, environmental controls and generators for invasive or non-invasive breathing assistance. 

We have simplified the NC Chapter grant process beginning 2nd period of 2019 (officially started July 21)! We no longer require an application in advance of the period you are applying. Instead, you will only complete one form for reimbursement. After you have paid for an eligible expense (that appears on the ALS Eligible Expenses List), complete the ‘Request for Funds’ form and submit with qualifying copies of receipts.

Benefits of new process:

  • Simplifies the paperwork
  • No application deadline to remember
  • Do not need to anticipate needs months ahead of time
  • Reduces overall wait time
  • The ALS Association NC Chapter can monitor budgeted money more accurately
  • More people can benefit from the grant monies


What stays the same:

  • List of eligible expenses o Includes virtual assistant/ home automation systems, i.e. Alexa, Google Home
  • Amount of grant – capped at $750 for each period
  • Date ranges for the two periods: o 1st period: January 21 - July 20 o 2nd period: July 21 – January 20
  • To receive monies during a grant period, receipts must be within that period’s range of dates (listed above)
  • No requests will be considered after hard deadlines of: o January 20 - for 2nd period o July 20 - for 1st period
  • Reimbursement is always based on availability of current funds



  • Primary residence must be in North Carolina
  • One time completion of ALS Verification Form, signed by an ALS clinic neurologist.  Chapter will keep form on file.  If you attend an ALS clinic, The ALS Association Care Services staff member will assist in getting this form completed. 


  • This is a reimbursement grant program.  Only items as stated on the ALS Eligible Expenses List, that you have already paid for during the current period, may be reimbursed up to the maximum amount of $750 per period. 
  • You are not required to hold and submit receipts for the entire amount of $750 at one time (although you can request the total amount).  You may submit the Request for Funds form with copies of different receipts up to three times during the period until the $750 cap is met. 
  • All requests are subject to the availability of funds at the time of submission.  Therefore, if partial reimbursement is initially received this does not automatically guarantee you will receive the rest of the $750 later. WHY? This allows us to track budgeted grant funds more precisely which gets more funds to those who need it in a timely manner. 


Step 1 - Check ALS Eligible Expenses list to make sure receipt(s) you are submitting are on the list of eligible expenses and be sure receipts are between the acceptable date ranges for current period.

*If you are unsure, please contact Claudia at or 919-390-0125 before submitting.

Step 2 - Complete Request for Funds form, Answer impact questions and Read and Sign responsibility statement. 

Step 3 - Attach copies of Receipt(s), you can use Mileage log or Respite Care Provider log if needed as receipts.

Step 4 - Return the completed Request for Funds form with copies of receipt(s) by:

The ALS Association North Carolina Chapter
4 Blount Street, Suite 200
Raleigh, NC 27601
Fax: 919-755-0910

Please retain a copy of your paperwork and original receipts for your records. You will only be notified if funds are not available.  You can dowload Request for Funds Packet and extra forms below:

Download Request for Funds Packet  This includes procedure and all forms below

Download ALS Eligible Expenses List  Please be sure to check this form to make sure expenses qualifty for reimbursement

Download Request for Funds Form This form MUST be completed, attached to an invoice/receipt and submitted for any reimbursements to be processed

Download Respite Care Provider Log This form is used by non-professional (cannot reside in pALS’ home) respite care providers. It must be completed by the care provider and sent in with Request for Funds form

Download Mileage Log  This form is used to submit reimbursementso for Mileage OR rental of vehicle/car service to and from ALS clinic appointments, North Carolina clinical trial appointments (when travel stipend not provided), Feeding tube, invasive ventilator and Baclofen pump procedures appointments ONLY

Step 5 - Receive check which can take up to 6 weeks.  Checks are processed and mailed approximately the 20th of each month.  Checks are void after 90 days and cannot be re-issued.  Please deposit when you receive.

  • Late requests will not be accepted, no exceptions.   See dates below.  Do not wait until the last minute.  If sending by regular mail, please allow enough time to be in our office by the deadline dates. 

TIP:  Add reminders to your calendar or smart phone so you get your paperwork in on time!


      Grant Periods       

       Request For Funds form along with eligible receipts MUST be
      received by:

      Receipts Must Be Dated Between
      Hard Deadline: July 20 Jan. 21 and July 20     
      Hard Deadline: January 20 July 21 and Jan. 20     

      For questions regarding the grant  reimbursement process, please contact Claudia Beirne, our senior care services programs manager, at