FINANCIAL ASSISTANCE Application
Jim’s Team 4 Diabetes is a nonprofit organization that offers financial assistance to individuals for the purchase of Diabetic equipment and supplies. First, please review the application criteria below to ensure that you are eligible. The application must be completed in full in order to have your request considered for funding. As a start-up organization, the Foundation will not consider requests that exceed $500 either separately or if combined with other items. Please type or print as clearly as possible.
- Individuals of any age with Type 1 or Type 2 Diabetes living in the USA.
- Applicants are welcomed to provide a written cover letter with information not covered in the application form about their child with Diabetes or of themselves (if responsible for their own diabetic health condition).
- For applicants submitting a non-paid claim from your Insurance Provider that specifically relates to purchases of Diabetic equipment or supplies, please enclose a copy of the statement and other relevant documentation that shows the account balance due.
- If you have no insurance and are the responsible party for the purchase of Diabetic equipment or supplies, please enclose a copy of the receipt(s).
- All applicants must provide a letter from a physician that certifies the individual’s status as T1D or T2D. Applicants will not be considered unless documentation is provided.
- Families and/or Individuals that meet the application criteria can apply for Financial Assistance once every 12-months so that the Foundation can help as many people as possible.
- All applications will be reviewed promptly, usually within one (1) week. All consideration for support is strictly based on available funding to the Foundation. The applicant will be notified by e-mail of the amount to be provided in advance of payment being made.
- All payments will be sent out by regular U.S. Mail within two (2) business days of the e-mail notification.
- Applying for Financial Assistance through this Foundation does not guarantee approval.
- THE FOUNDATION DOES NOT PROVIDE CASH ASSISTANCE OR PAY CREDITORS/VENDORS ON BEHALF OF THE APPLICANT.
- The Applicant is responsible for all local and state taxes when receiving a payment from the Jim’s Team 4 Diabetes Foundation.