Jim “Catfish” Hunter Chapter
Proudly serving all 100 counties and sponsor of all 5 ALS clinics in North Carolina
"Catfish" Chapter Quarterly Grant
**MUST BE A RESIDENT OF NORTH CAROLINA IN ORDER TO QUALIFY FOR THIS GRANT**
The "Catfish" Chapter Grant Program assists NC 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 one 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 (effective for 2nd quarter 2015 grant approvals) grant four times per year, but MUST apply separately for EACH quarter.
- Expenses must be directly related to ALS or PLS diagnosis. See "Eligible ALS Expenses List."
Steps to applying for a “Catfish” Chapter Quarterly Grant
***Please read instructions before applying***
Step 1: Please apply for grant below OR You may download the grant application (below) and complete, then send to us by mail, fax or email. Applications must be received (postmarked) by the "End of Quarter date" for that quarter (see dates below to determine quarter for which you are applying).
Step 2: Once we receive your application, you will receive verification either by email (or postal mail if we do not have your email address).
Step 3: Now you wait & save your receipts. DO NOT MAIL IN ANY RECEIPTS UNTIL AFTER YOU RECEIVE THE APPROVAL LETTER.
*Cancelled checks/copies of checks or credit card statement/bank statements are not acceptable as receipts.
*Receipts must be NO older then six months before the "End of Quarter Date" (Your approval letter will state this date & matches the table below).
Step 4: You will receive the approval letter 2 weeks after the "Grant Application Deadline" date (see table below) along with necessary forms.
Step 5: NOW, send in completed paperwork and receipts following the "Guidelines for Receipts" section on your "Reimbursement Request Form" that comes with your approval letter.
Step 6: Apply for next Quarter!
|QUARTER||APPLICATION DEADLINE||END OF QUARTER DATE|
|1st||January 20||April 20|
|2nd||April 20||July 20|
|4th||October 20||January 20|
- Apply Online
- Download Quarterly Grant Application (download form to complete and fax, email or mail to us).
Extra forms you may need After Grant Approval (Existing Grant Recipients Only)
THESE FORMS ARE ONLY IF EXTRA FORMS ARE NEEDED FOR A “CURRENT APPROVED” GRANT APPLICATION!
Download Rimbursement 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 Service Provider Receipt. This form 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 and sent in with a completed Reimbusement 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 our Care Services Programs Manager at Claudia@CatfishChapter.org