Grant Application Overview
Paint for a Cure was formed to help ease the burden of living with ALS for families with young children navigating this devastating disease. While we understand the financial strains and challenges all people experience with ALS and related diseases, this grant is specific to families with young children (under 18) and grants are designed to help with resources to live independently/preserve dignity/support family needs. 

Examples of How Paint for a Cure Helps Families: Bathroom additions/remodels to make ADA accessible; additions of master bedroom on first floor, addition of rails, lifts, ramps, etc., for home accessibility movement; grants towards wheelchair vans, supplemental caregivers; and unique needs, such as summer camp expenses for children, etc. 
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Email *
WHAT IS YOUR RELATIONSHIP TO THE PERSON WITH ALS NEEDING ASSISTANCE? *
WHAT IS YOUR PHONE NUMBER
Format - (XXX) XXX-XXXX
 *
FIRST / LAST NAME
PERSON NEEDING ASSISTANCE (with ALS)
 *
PREFERRED METHOD OF COMMUNICATION FOR PERSON WITH ALS (CHECK ALL THAT APPLY) *
Required
WHAT IS THE BEST WAY TO CONTACT THEM? THROUGH CAREGIVER, FAMILY MEMBER? *
PROVIDE HOME ADDRESS FOR PERSON WITH ALS
street, city, state, zip
 *
PHONE NUMBER FOR PERSON WITH ALS/CAREGIVER
Format - (XXX) XXX-XXXX
 *
EMAIL FOR PERSON WITH ALS/CAREGIVER *
ARE YOU CURRENTLY DISABLED? IF SO, WHAT CAPACITY? Please include if you are the person with ALS or filling this out on behalf of someone with ALS. *
TELL US ABOUT THE PERSON WITH ALS' CURRENT SPEAKING ABILITIES. Verbal, non-verbal, slurred speech, etc. *
TELL US ABOUT THE FAMILY. INCLUDE NAME(S)/AGE(S) OF CHILDREN. *
DESCRIBE YOUR REQUEST FOR ASSISTANCE AND PROVIDE ANY INFORMATION WE NEED TO KNOW. 
Please share how the donation will support the person with ALS and their family here.

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A copy of your responses will be emailed to the address you provided.
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