**MUST BE A RESIDENT OF NORTH CAROLINA IN ORDER TO QUALIFY FOR THIS 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.
- Applicants must have an "ALS Verification Form" signed by an ALS Clinic neurologist (only needs to be completed one time). Once we have a form on file, you do not need to complete again. If you are not sure if you have one on file, contact the chapter office.
- Applicants are eligible for a $750 grant twice a year, but MUST apply separately for EACH period. Grants will be awarded as long as funds are available
- Expenses must be directly related to ALS or PLS diagnosis. See "Eligible ALS Expenses List."
***WE ARE IN THE PROCESS OF CHANGING OUR GRANT APPLICATION
PROCEDURE. FOR THE 2ND PERIOD OF 2019 WE WILL ACCEPT
APPLICATIONS STARTING ON JULY 21ST, YOU DO NOT NEED TO SUBMIT AN APPLICATION
NOW FOR 2ND PER 2019.
MORE INFORMATION ABOUT OUR NEW GRANT PROCEDURE AND NEW STEPS ON APPLICATION PROCESS WILL BE
Steps for applying for a Chapter Grant
***Please read instructions before applying***
Step 1: Fill out the application form on front and sign on back. You may mail, email or fax the completed form. Applications must be received by January 20 for the first period and July 20 for the second period.
Step 2: Once we receive your application, you will be sent a verification by email or postal mail (if no email address is on file).
Step 3: You will receive notification regarding your approval or denial within two weeks after the grant application deadline date. (see table below)
Step 4: If you receive an approval letter, send in completed paperwork and receipts following the guidelines on the reimbursement request form included with your approval letter. DO NOT MAIL IN ANY RECEIPTS UNTIL AFTER YOU RECEIVE AN APPROVAL LETTER.
- Cancelled checks, copies or photos of checks, credit card statements/receipts, bank statements or insurance explanations of benefits are not acceptable as receipts.
*Approval of all grants will be based on available funds*
|| Application Deadline
|| Reimbursement Requests Must Be Received or Postmarked By
||Receipts Must Be Dated Between
|| July 20
|| Jan. 21 and July 20
||July 21 - Jan 20
|| Jan. 20
|| July 21 and Jan. 20
For a list of expenses that qualify for reimbursement, please click here. If the expenses are not on this list, they will not qualify for reimbursement.
Extra forms you may need after grant approval (Existing Grant Recipients Only)
THESE FORMS ARE TO BE USED ONLY IF EXTRA FORMS ARE NEEDED FOR A CURRENT APPROVED GRANT APPLICATION!
Download Reimbursement Request Form : This form MUST be completed, attached to an invoice/receipt and submitted for any reimbursements to be processed for a current approved grant.
Download the Respite Care Provider Log: This form can be used by non-professional (cannot reside in pALS’ home) respite care providers. It must be completed by the care provider and sent in with a completed reimbursement request form.
Download the Mileage Log: This form is used to submit reimbursements for mileage expenses (to and from clinic, clinical trials, feeding tube or diaphragm pacer appointments ONLY).
For questions regarding the grant application process or reimbursement process, please contact Claudia Beirne, our senior care services programs manager, at email@example.com.