Changing the lives of those we serve.

Family FUND ASSISTANCE

Please fill out this form and click submit. Our staff will process your request and send you a check within 2 weeks.

Name of child with SB

First Name

Last Name

Date of birth

Birthday Shout Out

We are doing social media birthday announcements for our members with spina bifida that include a photo and brief bio (first name, age, city of residence, hobbies and interests). We will email you prior to the month of this birth date to collect this information.

Yes, please email me for a birthday shout out and I give SBWIS permission to use the photo and information I provide on social media to acknowledge this birthday.

No thank you.

Name of person/place to make check out to

Parent or Legal Guardian, trust fund account or vendor/bank. All checks will be mailed to your home address.

First Name

Last Name

Home mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Wisconsin County you reside in

Family need:

Provide a brief description of what you'll use this money towards (must relate to needs of person with spina bifida)

Please share your suggestion(s) for additional ways SBWIS might support your family member with SB

Match and Meet

You are giving SBWIS permission to share your first name and email with other members to help you connect with peers.

We recognize your concerns about receiving this gift and the potential impact on SSI. Please provide the name of the person/business/organization the check should be made out to:

Provide the name of a trusted friend, credit card company, landlord, cable/mobile phone company or another third party. It is your responsibility to submit payment. Checks issued to a third party will not be reissued if lost.

How do you keep in touch with SBWIS?

Checking the website

Following Facebook posts

Newsletter postcard

Email blasts

Submit for Family Fund

Family FUND ASSISTANCE