SPINA BIFIDA AND HYDROCEPHALUS
ASSOCIATION OF NOVA SCOTIA
SPECIAL NEEDS FUND
What is The Special Needs Fund?
The Special Needs Fund is designed to alleviate some of the financial strains placed on parents of children with spina bifida and/or hydrocephalus and persons with spina bifida and/or hydrocephalus, when funds are not available from other sources. A limited amount of funds are budgeted annually, therefore applications are reviewed by the Executive Committee on a first come first served basis.
Who is Eligible?
1/Parents of children with spina bifida and/or hydrocephalus. Parents must be registered members in good standing of the Spina Bifida and Hydrocephalus Association of Nova Scotia in good standing for minimum of one year and residents of NS,NB,NL.
2/Persons with spina bifida and/or hydrocephalus (age 18 or over) who are registered membersof the Spina Bifida and Hydrocephalus Association of Nova Scotia in good standing for minimum of one year and residents of NS,NB,NL.
Coverage
The fund is designed to cover expenses that are not reimbursed by any medical plan, extended health benefit, service club or social assistance, ex: mobility equipment, aids to daily living, such as lifts, etc. Other special needs may be considered upon request.
Requirements
An application form must be completed and signed. Documentation of two price quotes for equipment (if available) must accompany the application form along with any letters of recommendation from an Occupational Therapist, Physiotherapist, Doctor or Social Worker (if applicable). A brochure or information sheet describing the equipment requested must also be attached. The member is also to provide a personal letter indicating why this piece of equipment is best suited to their needs.
Payment
Applications are reviewed by the Executive Committee and if approved, notification will be made immediately. Approved funds must be consumed within six (6) months of approval. The applicant can arrange to have the invoice sent directly from the supplier to SBHANS or make payment themselves and submit the receipt to SBHANS for reimbursement.
The Spina Bifida and Hydrocephalus
Association of Nova Scotia
c/o Sarah Williams
15 Laura Drive,RR4 Eastern Passage, N.S.B3G 1K3
Phone Toll Free (NS) 1-800-304-0450
SPECIAL NEEDS REQUEST FORM
FAMILY NAME:
CHILD/ADULT WITH SB:
DATE OF BIRTH: SB:HYDROCEPHALUS
FATHER'S FIRST NAME:
MOTHER'S FIRST NAME:
ADDRESS:
TOWN/CITY: POSTAL CODE:
PHONE:EMAIL:
***********************************************
ITEM REQUIRED:
TOTAL COST:
REASON FOR REQUEST:
DO YOU HAVE MEDICAL INSURANCE THAT COVERS ANY OF THE COST? ______
HAVE YOU REQUESTED ASSISTANCE FROM ANOTHER AGENCY/ORGANIZATION? YES___
NO IF SO, HOW MUCH ASSISTANCE HAVE YOU RECEIVED FROM THIS SOURCE?
I HEREBY CERTIFY THAT THE INFORMATION GIVEN HERE IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE,
SIGNATURE DATE
NOTE: Along with this completed application, SBHANS requires price quotes for the item requested, a brochure or information sheet on the item requested and a personal letter stating why this item best suites the needs of the recipientas well as any documents of need made by an Occupational or Physiotherapist. SBHANS reserves the right to request more information and price quotes.
For Office Use Only:
Membership ConfirmedQuote Included
Letter(s) of RecommendationBrochure/Other Information
Personal LetterResident of NS,NB,NL
website: Email: Registered Charitable No. 0685180-11