Family Service Fund Application for Caregivers

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Attached is the FSF application.  NEW THIS YEAR! is a tax form that needs to be filled out with the name and info for the caregiver before returning.  Missouri caregivers are able to access up to $1,000 for eligible expenses incurred after the acceptance date of the application, with the receipts received in our office by the end of May. We can pay for services used in June, as long as they are prepaid and the receipt is in our office by May 31.  

One thing we suggest is for people to buy incontinence supplies for up to a 6 month period.  Same with Boost or Ensure.  

Completed applications may be emailed to dianna@northlandsc.org, along with proof of diagnosis and the tax form. Please contact us if you have any questions!  

Family_Service_Fund_Application_2016.pdf
W-9_form.pdf