Emergency Assistance Fund

Emergency Assistance Fund is sponsored by Epilepsy Foundation of Colorado and Wyoming. This fund offers short-term financial support and resources to individuals and families affected by epilepsy in Colorado and Wyoming during an acute, one-time financial crisis.

Emergency Assistance Funds - Epilepsy Foundation of Colorado and Wyoming Emergency Assistance Funds The Emergency Assistance Fund provides short-term financial support and resources to individuals and families affected by epilepsy in Colorado and Wyoming. The fund is intended to help during an acute, one-time financial crisis. It is not designed to provide ongoing financial assistance or long-term sustainability.

Residency: Applicants must reside in Colorado or Wyoming and be directly impacted by epilepsy. Frequency of Support: Applicants who receive funding for two consecutive calendar years are not eligible for additional assistance for the following 24 months . All requests are evaluated on a case-by-case basis.

Decisions are based on multiple factors, including individual circumstances and the Foundation’s current budget. The amount and type of assistance may vary depending on need and available resources. Review Eligibility Criteria before completing this application Incomplete applications may be subject to denial.

Proof of diagnosis and other supporting documents may be requested upon review of application. Once the application and all supporting documents are received, it can take up to 5 business days to process the application. To qualify for Emergency Assistance Funding, applicants must meet the following criteria: Diagnosis of epilepsy .

Documentation may be requested. Approved forms include a photo of your prescription or letter from your doctor. Need must be related to the effects of epilepsy.

Assistance must benefit the person with epilepsy or their immediate family members/care partners. Assistance requested/provided does not duplicate other aid received for the same costs. Financial need will be determined using standard income guidelines as a reference point.

If your household income is above these guidelines but you experience increased expenses related to epilepsy, please explain this in the application. Comments This field is for validation purposes and should be left unchanged. Are you currently working with an Epilepsy Foundation team member?

(Required) Team member you are working with (Required) Marcee Aude Chelsi Barraza Marissa Cardenas Raleigh Cooper Rebecca Engle Bergen Hartmann Larissa Hill Danielle Miller Sara Prevost Other Other team member you are working with (Required) Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Neurologist's Name (Required) Neurologist's Address (Required) Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Neurologist's Phone (Required) Type of Seizures (Required) Gross Household Annual Income (Required) Enter numbers only Number of People in Household (Required) Other Assistance Requested Do you receive assistance from other organizations/sources?

(Required) Other Assistance Please name any other organizations from which you have requested assistance and whether you received assistance or not. Documentation may be requested. Use the blue + sign at the end of the row to add up to five additional sources of assistance.

Assistance Received (Y or N) Have you lost health insurance coverage? (Required) Would you like to receive case management services? (Required) What are you requesting assistance for?

(Required) Reason for financial assistance (Required) Describe your situation and reason for needing financial assistance. What would receiving this funding mean to you/your family? (Required) (This section may be used in promotional materials; identifying details will be removed.)

This field is hidden when viewing the form Steps for Financial Improvement (Required) Please share three steps you will take in the next few months to improve your financial situation (e.g., ways to earn more, spend less, or save better). This section must be completed for your application to be I certify that the information provided on this application is true and complete without omissions.

I understand that any misleading or incorrect statements may void this application. I have read, understand, and by my signature consent to these statements. Consent (Required) I agree that my personal data may be stored and processed to respond to my request.

9 am - 3 pm on Wednesday's, or by appointment . Epilepsy & Seizures 24-hour hotline: