Note: We are sorry to inform you, but we are currently not accepting any more applications at this time due to a high volume on the current waiting list. Once we are able to assist those applicants we will remove this message. We greatly apologize, but we need more funds to make it possible for applicants to get assistance. Thank you.
Click below to print out your Application for Assistance. (*Don't forget the fax cover sheet below!)
*The 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.
Copyright 2009-2012 Brain Injury Hope Foundation Brain Injury Hope Foundation, Post Office Box 1319, Boulder, CO 80306 Tel. 303-484-2126