Paul LaRochelle Quality of Life Grant
1. Primary residence is in Maine, New Hampshire or Vermont
2. Registered with the ALS Association Northern New England Chapter
3. One-time completion of an ALS Verification Form signed by a neurologist
• This is a reimbursement grant program. Only items as stated on the ALS Eligible Expenses List that you have already paid for during the current period, may be reimbursed up to the maximum amount of $500 per year.
• You are not required to hold and submit receipts for the entire amount at one time (although you can request the total amount). You may submit Request for Funds form with different receipts up to two (2) times during the year.
• All requests are subject to the availability of funds at the time of submission. Therefore, if partial reimbursement is initially received this does not guarantee you will receive the balance amount the second time you submit. WHY? This allows us to track budgeted grant funds more precisely which gets more funds to those who need it in a timely manner.
What do I need to do?
Step 1 - Contact your Care Services Coordinator to discuss the Funds Request Packet
Step 2 - Check Grant Periods table (below)
Step 3 - Complete Request for Funds form
Step 4 - Return the completed Request for Funds form with receipt(s) by mail, email or fax.
You will be notified whether your request is being processed or funds are not available. Checks can take up to 3 weeks
Late requests cannot be accepted. See dates below.
IMPORTANT DATES TO REMEMBER
Care Services Contact
Each state has a Care Services Manager. Please call the representative in your area with your questions or to request a packet:
• Maine: Darby McMillen 207-200-9613 or email: email@example.com
• New Hampshire: Patricia Luoma 603-458-4718 or email: firstname.lastname@example.org
• Vermont: Karin Hamer-Williamson 802-662-4809 or email: email@example.com