The Application for Assistance form MUST be completed by a referring professional for your application to be considered. Please answer the questions completely so we have all the information the first time around. (Put 'N/A' if the information doesn't pertain to you) Thank you.
After the referring professional fills out your Application for Assistance (with you present), immediately fax or mail it to the Brain Injury Hope Foundation including the fax cover sheet.
*Remember processing your application can take a considered amount of time. Please be aware that funds might not be available. You will get a confirmation of us receiving your application by phone/mail/email within 2 weeks. Thank you for your patience and understanding.
