Equipment/Supplies

Moving Mountains Foundation helps ensure that individuals with disabilities are afforded the opportunity to live a life where daily living tasks are possible. Oftentimes, increased levels of independence for individuals with disabilities can be achieved with improved access to needed medical equipment, supplies, or disability aid support that they need. Moving Mountains Foundation helps fund medical equipment and supplies while also financing aids and assistants that help persons with disabilities travel, communicate with others, learn, work, and participate in social and recreational activities.

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Application Criteria 

  • Applicants must have an immediate need for treatment or documented medical support and if treatment is not found, the applicant’s physical safety is in jeopardy

  • The income level of the applicant’s family must be below $45,000/year

  • The case must involve an individual with a specific and documented health care need

  • The request must be clinically relevant to the health of the child or adult with a documented health care need

  • There must be no existing insurance coverage for the requested expenses

Application Process 

  1. Fill out the application completely and legibly. Incomplete or illegible applications cannot be processed.

  2. Email your completed application to: laura@mmtherapycenter.com

  3. Moving Mountains Foundation will respond to your email within four weeks of it being sent either requesting more information or stating whether or not your request will move to the formal decision stage.

  4. As soon as Moving Mountains Foundation has all of the needed information from you, the case will be decided at Moving Mountains Foundation monthly board meeting. 

  5. If approved, Moving Mountains Foundation will send funding to the provider or organization (not the family) within three weeks of approval.  Rx: If approved, Moving Mountains Foundation will pay the vendor (not the organization or individual) directly on behalf of the recipient.

  6. Funds must be used within twelve months of the date granted. All unused funds will be returned to Moving Mountains Foundation.

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Moving Mountains Foundation

Application for Assistance

***If applying as an organization only fill out responsible party and organizations name*** 

 

Applicant’s or organizations name: __________________________________   Date of Birth: __________

 

Age: _________ Gender:   □ Male    □ Female     Diagnosis: __________________________________ 

  

Responsible Party (If applicable): ___________________________________

 

Address: ______________________________  City:__________________ State: ______  Zip: ____________ 

  

Telephone: (Home): __________________   (Email): _______________   

  

Household Information 

 

Child lives with___________________________ Number of dependents in household: _____________________

  

Household annual income: _____________

 

Emergency Contact Name:______________________________________Telephone:____________________ 

 

  

Funding Information Does the individual have health insurance? Yes____No____  

  

Has funding been requested from additional sources? Yes____No____ 

 

If yes, please list why funding was not provided: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

  

Amount requested from Moving Mountains Foundation $ ___________________ 

 

Medical Information (Health care professional associated with funding request) 

  

Healthcare professional’s name: _________________________________ Clinic Name: _____________________

  

Address: ______________________________  City:__________________ State: ______  Zip: _____________ 

  

Telephone: ____________________________   Fax: ______________________________________________