2024 GRIN2B Foundation Patient Assistance Grant  (PAG)
Please note the following before completing the application:

1. The GRIN2B Foundation Patient Assistance Grant Program (PAG) is for families with a child diagnosed on a genetic report with a GRIN2B variant.

2. In order to qualify for the assistance program, recipients must be on the GRIN2B Foundation Family Registry (http://grin2b.com/register). Please register if you haven't already done so.

3. Please email supporting documentation (letter of medical necessity, insurance denial letter, etc.) pertaining to the nature of your request to brittaney.crider@grin2b.com. The insurance denial letter is required. The letter of medical necessity is preferred, but not required. We reserve the right to request additional documentation, if needed.

4. The patient assistance program will cover up to $1500 (U.S. dollars) per family a year, with a life-time award maximum of $5,000.

5. If your application is approved, grants are provided for new equipment/services only and will be paid directly to the vendor. You will be responsible for providing us an invoice from the vendor or instructions on how to pay the vendor directly.

6. Please be sure to complete the full application and hit "Submit." We will not be able to consider incomplete applications.

Disclaimer: GRIN2B Foundation is a 501c3 non-profit organization and does not discriminate against age, gender, sexual orientation, race, disability or religion.

By awarding these grants, GRIN2B Foundation is making no recommendation to the appropriateness or safety of any particular piece of equipment or therapy in treating GRIN2B Related Neurodevelopmental Disorder. The GRIN2B Foundation and its Board of Directors are not responsible for the safety and use of awarded equipment or therapies. Applicants are strongly urged to consult with their medical professionals and therapists regarding equipment and therapies that would be most beneficial for their situation.

We will not divulge application information without written consent from the applicant or their legal guardian. We do ask that award recipients submit a photo showing the child using their equipment or therapy that we may use for the advertising purposes of this grant program. Children will only be identified by their first name and only with written consent of their guardian.

The information requested is necessary to process your application. All information provided will be reviewed only by the Board and Clinical Advisors and will remain strictly confidential.

For questions on this program or application questions, please reach out to brittaney.crider@grin2b.com.
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Do you agree to the above terms? *
First Name *
Last Name *
Patient Full Name *
Email *
Phone Number *
Mailing Address *
Have you previously applied to the GRIN2B Equipment Assistance program? *
Please describe in detail your request. *
How will receiving this grant benefit your GRIN2B loved one and your family? *
How much are you requesting? (up to $1,500 US dollars) *
I acknowledge that if my grant is approved, I will provide GRIN2B Foundation with a picture of my child and a testimonial to be used on any of the following - website, social media, flyers, brochures, newsletters, etc. *
By checking this box I affirm that all of the information entered is accurate to the best of my knowledge. *
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