Nephrotic Syndrome Foundation Direct Patient Grants (DPG) Application
Welcome to the Nephrotic Syndrome Foundation (NSF) Grant Application. Before beginning your application, please read the following information and then click NEXT at the bottom of the page to begin.
Purpose
This program is intended to provide support and / or ease the financial burden that affects those caring for a child diagnosed with Nephrotic Syndrome. Our program is currently offering awards, between $500 - $1,500. These funds may be utilized for a diverse array of needs including items such as medication, counseling, individual coaching / tutoring, special classroom cleanliness preparations, experiences, tools or other expenses related to managing the disease / impact from the disease.
Grants are not determined / awarded solely based on financial need, but rather the impact / value the award will provide to the person diagnosed, family, and community.
Candidate Eligibility
1. Applicant (requestor) must be the primary caregiver of a child, 18 or under, diagnosed with nephrotic syndrome; (an exception to extend the age beyond 18 to 22 may be granted provided the family has been active with NSF (attending at least one event) prior to the child turning 18.) and
2. Child / family must reside in the San Francisco Bay Area OR have participated in a Nephrotic Syndrome Foundation event within the last 24 months.
Timing of Application & Awards
1. Applications may be submitted any time throughout the year.
2. Additional supporting documentation for the fund requests, such as quotes or provider treatment bills, etc, should be emailed to grants@nephroticsyndromefoundation.org within 7 days of application submission.
3. Applications will be reviewed on a quarterly / semi annual basis by the Nephrotic Syndrome Foundation's DPG Committee, or as schedule allows. All applications in queue (and complete) at the time of review will be considered.
4. Funds must be used within 12 months of award date.
5. The funds will be distributed directly to provider or vendors for services or needs.
6. We estimate 2 or more application selections will be made per award cycle; however, final determination of awards will depend on the number of submissions received and amounts requested.
Additional Award Notes:
If awarded, NSF shall distribute funds directly to a third party vendor vs. distributing to an individual due to individual tax considerations. Please review carefully the acknowledgements on the last page prior to submitting the application to understand the award expectations and considerations.
Thank you!
Please click next to begin your application
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Requestor Information
(the requestor must be the primary caregiver)
Requestor Name
*
First Name
Last Name
Requestor Email
*
example@example.com
Requestor Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Requestor Phone Number
-
Area Code
Phone Number
Requestor (primary caregiver) relationship to patient
(i.e. parent, friend of family, aunt, uncle, etc.. )
Please confirm eligibility by checking the applicable checkboxes
If not in the SF Bay Area, provide the NSF events attended:
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Patient Details
Patient Name
First Name
Last Name
Patient's Birthday
-
Month
-
Day
Year
Date
Patient Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Patient Age at Diagosis
Patient Diagnosis
Hospital where treated
Enter hospital full name and city. If multiple, enter the hospital at diagnosis
Who lives with the patient (child)
Please list all names and relationship to child of those that live in the home(s)
Patient parent names
Enter parent names if different than requestor
Please note, by entering this information you acknowledge and authorize NSF to save the data. Information provided will only be used for purposes of reviewing and / or evaluation of the requested grant.
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Award Request
Amount requested
*
Enter amount between $500 - $1,500
What is is being requested?
Please provide specific detail as to what is being requested
Please email any evidence supporting the requested expenses, i.e. screenshots of the event costs, quotes, provider bills/estimates to grants@nephroticsyndromefoundation.org within 7 days of submitting the application.
Enter the specific provider / company** you wish for NSF to directly distribute the award proceeds to?
i.e. therapist, tutor, health care provider, etc.
** NSF will provide support in the form of direct payment to a third party. The applications must be submitted with this information to be considered in the review process.
How would receiving this grant impact the patient?
Describe the impact from the child's perspective
How would receiving the grant impact the family?
Describe the benefit / impact of the award to the family
Describe how receiving this grant impacts the community? (i.e. other entity, school, etc.)
Local community could be schools, other entities, groups, etc
Describe any other benefits / impacts that would be achieved by receiving the award not already described.
Provide a description or enter 'none'.
Overall, how has your family's life been impacted by nephrotic syndrome?
Provide details, such as special classroom preparation, work impact, etc.
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Award Acknowledgement
Terms and conditions if awarded
Read and check each box. By checking the box, you agree to the terms and conditions if awarded the NSF grant.
*
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Submit
To submit the application, click "Preview and Submit," scroll to the bottom of the preview screen and click "Submit."
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