Financial Assistance Program

Grant Guidelines and Criteria for Funding

Please carefully review the Financial Assistance Program’s Policies and Procedures, in addition to the following Guidelines and Criteria before applying.

WithAll Has Full Discretion to Award a Grant:

WithAll reviews and approves requests on a case-by-case basis, always at its own discretion. WithAll reserves the right to reject a grant request according to its own discretion.

Grant Requirements:

Individual must have an eating disorder diagnosis and be in, or actively seeking, treatment in an intensive program treatment setting. Intensive programs include Intensive Outpatient, Intensive Day/Partial Hospitalization, and Residential Treatment. Please note that WithAll defines “intensive treatment” as at least 9 hours a week.
Applicant must provide a completed, current application with signed release forms to be considered.

Eligible Requests:

Past living-expense needs that have been approved for a grant award have included expenses such as rent for the primary place of living (i.e. not treatment lodging), food, gas, utilities, and similar expenses.

Ineligible Requests:

WithAll has repeatedly not approved grant awards for expenses such as treatment-specific lodging, expenses accrued from past treatment programming, medical bills (co-pays, insurance premiums, lodging), prescriptions, alternative medicines, therapy bills, loan payments, credit card payments and late fees, payment of medical bills, lodging expenses related to treatment, prescriptions, or alternative medicines.

Administration:

Within 24 hours applicants will be emailed an 'application received' notice. If such a notice is not received within 24 hours, applicants should contact WithAll by email at hello@withall.org.
After a grant award is approved, the award will be available to the applicant for only 30 days. If an individual fails to submit the grant acceptance form within 30 days of the original offer, the individual must reapply for assistance.
Grants will be limited based on availability. An individual is only able to receive one Financial Assistance Award throughout the course of WithAll’s fiscal year (July 1-June 30).
Funding is allocated monthly so that grants can be available for the majority of the year. Therefore, if the allotted amount has been granted for the month, applications will be placed on a wait list until the 1 st of the next month. Applicants will be notified if their application is wait listed.
Approved grants take approximately three weeks to process. If a grant check is not received within three weeks after the grantee submits their "Award Acceptance Form," WithAll should be contacted by email at hello@withall.org.

Please be advised that the provision of a grant to a recipient is in no way intended to be an endorsement or recommendation of any particular health care provider or treatment modality. Treatment of a medical/mental health condition involves complex medical decisions requiring the independent and informed judgment of an appropriate health care professional. All specific questions regarding your medical and mental health treatment and care should be posed to your professional health care provider.

Financial Assistance Program

Application

Page 1

Instructions: All questions must be answered. You will receive a confirmation email noting we have received your application within 24 hours. The email will share the timeline for receiving funding at the time of application. For more information on the grant processing timeline, review the Program’s Policies and Procedures.

Applicant Information

Do you have a current eating disorder diagnosis from a medical professional?

YesNo

***You must have a current diagnosis to be eligible for this grant.

First Name

Last Name

Mailing Street

City

State

Zip Code

Date of Birth

Phone Number

Email Address

Gender identity (optional):

Ethnicity (optional):

If awarded, I agree to fill out a survey 2 months after award date (required with award)

I agree

How did you hear about WithAll?

How Heard, if Other

I would like to be added to WithAll's email and mailing list:

YesNo

Financial Assistance Program

Application

Page 2

Answer all the questions below in order to be considered for a grant. Please note that certain questions determine your eligibility. If you are ineligible, you can cease filling out the application.

Application Questions

What type of intensive treatment are you currently in or seeking? You must be in an intensive program to be eligible for this grant. Please note that WithAll defines “intensive treatment” as at least 9 hours a week.

Treatment Type, if Other

How many hours per week are you in the treatment program?

What is your anticipated length of treatment in weeks? (If you are unsure, please enter your minimum or best estimate):

Provide explanation and justification as to why you need this grant, explanation and details as to the nature of the expenses to be covered, and perspective as to why these needs cannot be covered from another source:

Expenses

Please use the chart below to outline the cost associated with each expense for which you are requesting assistance. The costs should equal the amount requested.

Please note the following expenses are NOT eligible for funding: treatment-specific lodging, expenses accrued from past treatment programming, medical bills (co-pays, insurance premiums, lodging), prescriptions, alternative medicines, therapy bills, loan payments, credit card payments and late fees.

Expense

Cost

Expense

Cost

Expense

Cost

Expense

Cost

Expense

Cost

Expense

Cost

Amount Requested ($1 - $500)

Please note by submitting this application form you consent to WithAll using the information you provide herein, including exact quotes, to illustrate to WithAll’s audience and supporters the need for, and benefits of, this grant program. WithAll will always work to maintain your privacy and anonymity. As such, we will never share personally identifiable information or your real name.

If this is of concern to you, please contact WithAll prior to submitting the application at hello@withall.org

Financial Assistance Program

Application

Page 3

Release Form

I declare that the information on this application is true and correct to the best of my knowledge. I understand that all applications for WithAll’s Financial Assistance Program are reviewed on a case-by-case basis and final determination is made by WithAll.

Sign by typing your Full Name

Signature/Electric Signature: I hereby acknowledge that I am the applicant designated above. I have carefully read and understand the contents herein and sign it of my own free will and with full knowledge of its significance. In accordance with the Federal E-Sign Act, I understand that I have the option to request a paper copy of this document, rather than signing electronically, below. Alternatively, to sign the document electronically, please type your name here, to verify you agree to the above language of this agreement.

Signed Date

While all information on the application is treated with great care and shared only with those who must know names/identities in order to operate the program, applicants should be aware that WithAll uses online tools and software. As such, WithAll cannot and does not guarantee the privacy, security or confidentiality of any information that applicant shares with WithAll as part of their application for a grant from WithAll’s Financial Assistance Program. Since online tools and software are internet based, there is the potential that the information shared could be intercepted, altered, forwarded, and/or read by others. Please keep these privacy limitations in mind while filling out this application.

Contact Information