2024 Financial Assistance Application
NOTE: In 2024, the annual amount an individual with Spina Bifida can receive from combined grant and scholarship funds cannot exceed $1,000. You MUST submit a new application for each monetary amount requested. In order to receive reimbursement, a paid receipt must be submitted. Otherwise, a bill must be submitted and payment will be made directly to the provider. 

Families are invited to request up to $1,000 of Financial Assistance which can be used for but not including medical assistance, therapy, equipment and more.  SBSTL will notify you as soon as possible based on the date the request is received and the next scheduled Board Meeting.  Financial Assistance is limited and is offered on a first come, first served basis, annually.

BY SUBMITTING THE FORM  I CERTIFY THAT ALL THE INFORMATION PROVIDED IS TRUE AND CORRECT. I CERTIFY THAT THE ITEMS LISTED ARE FOR THE BENEFIT OF THE APPLICANT. IF ANY INFORMATION IS INTENTIONALLY FALSE, I AGREE TO REIMBURSE SBSTL ALL COSTS LEGAL AND OTHERWISE, TO RECOVER THE DISBURSED FUNDS.

All supporting documents (receipts, invoices, etc..) must be sent to sbstl@charter.net.

The $1,000 is an annual limit per individual for all 3 Grants , i.e. an individual in the same calendar year cannot receive a $1,000 Activity Scholarship and a $1,000 Financial Scholarship.
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Email *
Today's Date *
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Name of Individual with Spina Bifida *
Birth Date of Individual with Spina Bifida *
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Name of Parents or Guardian (if under 18) *
Street Address *
City *
State *
Zipcode *
Phone Number *
Name & Description of Item(s) Requested *
Amount Requested *
Contact Name and Phone Number *
Make Check Payable To
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