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Need Assistance

 

MDFF is currently taking applications for residents in the state of Indiana who need help or assistance in the following areas:

  1.  Van-A-Year program.   A customized wheelchair-accessible van will be awarded to an MD family in need of reliable transportation.  Applications were due April 30, 2017.  The 2017 recipient will be notified in June and the van will be presented in September at the Bowling Extravaganza in Indianapolis.  Applications for 2018 will be available in January 2018.
  2. Financial assistance with adaptive equipment, home or automobile modifications to improve mobility and independence.
  3. Financial assistance with medical equipment that is not fully covered by private insurance.

The process begins with the completion of a short application.  If general qualifications are met, a more in-depth application will be requested.

Note: MDFF is currently only assisting individuals and families in the state of Indiana.

Name of person completing this request

Name of person with Muscular Dystrophy (if different) needing assistance

Your email

Do You live in Indiana in the United States?
noyes

Address

Address 2

City

State

Zip

Phone

Birth date of person needing assistance

Have you been diagnosed by a physician to have a form of Muscular Dystrophy?
YesNo

What form of Muscular Dystrophy have you been diagnosed with?

Requested item/service

If this is medical equipment, have you consulted with your doctor about the appropriateness & fit? Please also let us know if this is expected to be a short-term or a long-term solution based on future expectations with your condition.

Do you have a written estimate?
YesNo

If yes, please provide the dollar amount $

Description of how the requested item/service will provide assistance (e.g., how long has the need existed, and if need is not met, what are your ongoing limitations?)

If financial assistance from MDFF is not received, what is your plan to pay for this need?

I understand that by completing this information that additional documentation may be required including such items as bank statements, most recent tax return, and a record of related medical expenses

No Boundaries