Help 4 HD International Incorporated is a nonprofit 501(c)(3) public charity.  The Help 4 HD Relief Fund program was formed to provide emergency support to JHD/HD families in dire need.  Providing education, information, resources, and support to our HD and JHD community is vital to our mission. This grant is for individuals who meet specific criteria. However, if there are extenuating circumstances outside the specific requirements, the Executive Board may approve a specific case after review.  

*All applicants must fill out all application fields.

*All receipts for expenditures related to the use of this fund must be mailed back to Help 4 HD International Inc. within 30 days as proof that funds have been spent according to agreed-upon guidelines.

*The information outlined in this application is personal, medical, and confidential.  This information will not be used in any way other than to determine eligibility.


APPLICATION AND REQUIREMENTS

WHO QUALIFIES?
A US citizen that resides in the United States
An individual who has HD or JHD
An individual who is 18 years old or older

A legal guardian or caregiver of an individual who suffers from JHD/HD
An individual who meets the above criteria and has exhausted all local and state resources
An individual who is on SSI, SSDI, Medicaid, Medicare or any combination
 
IF YOU QUALIFY, YOU WILL NEED TO PROVIDE:
Proof of expense you need assistance for                              
Proof of income                                                                                  
                                                                                                                                                                                                          
WHO DOES NOT QUALIFY
Persons whose household income exceeds $25,000 per year
Persons who work more than 20 hours per week
Persons who have already received Help 4 HD Relief in the past 12 months
 
WHAT WE WILL PROVIDE (Updated and revisited annually by the Executive Board)
Information about community resources
Funds to help pay for, but not limited to, utility bills, rent, and other necessities

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* 1. Address

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* 2. Please provide a description of the relief needed.

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* 5. By checking these boxes, you are acknowledging that these statements are true for your circumstances. Please check all that apply.

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* 6. By filling in my name below, I acknowledge that all the information I have provided in this application is true. I acknowledge that any false information given in this application will result in a denial of financial assistance. I will provide proof within 30 calendar days that relief funds were used for the purpose approved by Help 4 HD International. Failure to do so will result in funds having to be returned to Help 4 HD International.

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