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the smith fund

Every year the Spinal Injury Foundation sets aside a number of $1,000 grants for injured people who need a helping hand. The genesis of this fund was a young man with a severe spinal injury for whom the pain became too much to bear. This fund is to remember Ian and to allow him to continue to give to others. If Ian's memory can show one person that there is hope, then we know we will have served his memory well. The funds can only be paid directly to bill collectors such as rent, lights, heat, etc...not to third parties. If you know a candidate for this fund, please take the time to fill out the form below. Grant applications are reviewed in January each year. Applications are now closed for the 2008 Smith Fund. Applications will be reopened Sept 15, 2009 to Nov 30 2009

grant application form

ALL fields are required. 

Patient's Last Name:             

Patient's First Name:              

Contact Phone:                      

Your e-mail:                          

Date of Accident:                  

**Please note: This grant does not cover congenital defects or disease processes**

Spinal Injury(s) Sustained (include detailed information on how the injury occurred):

Treatment(s) Undergone for Spinal Injury (please be specific):

The patient's story (please elaborate on any financial, emotional, or physical concerns)...Please write down the amount of money you have made in the last 12 months.

In the event an award is made, the applicant must be able to legally document their Adjusted Gross Income and Interest and Dividend Income (i.e. copies of 1040 Tax Form or SSDI Forms), and consent to publication of photograph and story on the Spinal Injury Foundation website and in a press release.  In addition, reporters in your area may wish to contact you for an interview. Please click here and fill out this pain questionnaire before returning to submit this form

By hitting "Submit Application", I (as the person nominated) agree to the following should I be selected for an award:

· Submission of legal documentation of 2007 Adjusted Gross Income

· Submission of legal documentation of 2007 Dividend Income

· Consent to publication of name, personal photograph and personal story on the SIF website and in SIF sponsored publications.

· Availability for personal interviews as deemed appropriate.

I understand that the my application will be reviewed the following October 1 after the date I apply.