The ALS Association Jim "Catfish" Hunter Chapter
Catfish Chapter Quarterly Grant
MUST BE A RESIDENT OF NORTH CAROLINA IN ORDER TO QUALIFY FOR THIS GRANT
The "Catfish" Chapter Grant Program assists 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, computer access, communication devices, environmental controls and generators for invasive or non-invasive breathing assistance. Recipients may apply for and receive four grants per year in the amount of $625 each. Grants will be awarded quarterly on a first come first served basis and based on available funds. First time applicants will be given priority.
Steps to applying for an ALS Association Jim “Catfish” Hunter Chapter Quarterly Grant ***Please read instructions carefully*** Needs Must be directly related to ALS or PLS diagnosis
Step 1: Fill out the application form (Make sure you fill out the front and back of form and sign it), or complete form online. *If this is your first time completing an application make sure a Verification of ALS/PLS Diagnosis form is completed by an experienced Neurologist. Your Clinic Social Worker can assist you with this. If you are not sure if you have a form on file with us, call the chapter office.
Step 2: Once we receive your application, you will receive a notification either by email or mail (if there is no email address on file) stating that we’ve received your application. If you do not hear from us within two weeks, please contact Claudia Winkler either by phone or email at: 1-877-568-4347 ext.225 or email@example.com
The Quarter which you are applying for will be determined by the date you send in your application *Refer to date range chart below
Step 3: Now you wait until the deadline for that quarter. Start saving your receipts that fall within the acceptable date ranges as listed in the table). DO NOT MAIL IN ANY RECEIPTS UNTIL AFTER YOU RECEIVE THE APPROVAL LETTER. One to two weeks after the deadline for that quarter, you will receive notification of your grant Approval along with the necessary paperwork (Billing Statement Reimbursement form, Grant Service Receipt form, and Mileage Log form) as well as instructions on how to submit receipts for reimbursement. You may NOW start sending in completed paperwork and receipts. Remember only receipts that fall within acceptable date ranges will be processed for reimbursement. All Reimbursements Requests require a completed Billing Statement for Reimbursement form to be sent in with receipts. Note: We need copies of actual receipts. Cancelled checks, credit card statements or bank statements are not acceptable.
Ranges for Receipts
|Receipts Due By:
|1st||January 20||Last week of January||October 21-April 20||April 20|
|2nd||April 20||Last week of April||January 21-July 20||July 20|
||Last week of July
||April 21-October 20
|4th||October 20||Last week of October
||July 21-January 20
Step 4: You may now re-apply for the next quarter’s grant. Keep in mind that you have a 6 month window of time for each grant for qualifying receipts. (3 months before grant approval date and 3 months after grant approval date.)
FOR A LIST OF EXPENSES THAT MAY OR MAY NOT BE REIMBURSABLE PLEASE click here.
Extra forms you may need After Grant Approval (Existing Grant Recipients Only)
THESE FORMS ARE ONLY IF THEY ARE NEEDED FOR A “CURRENT APPROVED” GRANT APPLICATION!
Download the Billing Statement for Reimbursement 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 Grant Service Receipt. This can be used by service providers who do not have their own receipt for services that they have provided. It must be completed by the Service Provider.
Download the Transportation Mileage Log. This form is used to submit reimbursements for travel expenses (to and from Clinic, Clinical Trials or Feeding Tube appointments only).
For questions regarding the grant application process or reimbursement process, please contact our Care Services Programs Manager at Claudia@catfishchapter.org