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This field will populate based on the URL/link used and will then load the correct form information, or the alert that it's closed if the RSP Application Open = No. RSP Link = https://www.tfaforms.com/4907854&tfa_183=RSP and R4A link = https://www.tfaforms.com/4907854&tfa_183=R4A
Set the Default value of this field to Yes or No depending on the current status. This will control whether the person visiting the link sees the application or the Application Closed information.
Application Closed
The Recovery Support Program application is currently closed, either because applications for this month have already exceeded the number we accept, or because the first week application window has closed.  Please revisit this link on the 1st of next month.  Thank you!

WithAll’s Recovery Support Program 


Grant Requirements and Process for Funding 


WithAll’s Recovery Support Program provides living-expense grants to individuals seeking intensive treatment for an eating disorder. Grant funds are awarded to cover the cost of the applicant’s top financial stressor (groceries, transportation, rent/mortgage or childcare) for their full length of treatment up to 20 weeks.

Please carefully review the requirements and process below before applying.

You are eligible to apply if

  • You have an eating disorder diagnosis from a medical provider.
  • You are in an intensive program treatment setting. An intensive program is defined as at least 9 hours a week and can include Intensive Outpatient, Intensive Day/Partial Hospitalization, and Residential Treatment.

Information needed to apply

  • If applying for rent/mortgage or childcare support, you will be asked to upload a bill, statement, lease, or letter showing the monthly or weekly fee for this expense. 
  • If applying for groceries or transportation support, you will be asked to upload a receipt or similar showing the need for this expense.
  • Name and phone number of your treatment provider who can verify your enrollment and level of treatment.
Eligible Requests
  • Groceries
  • Transportation to and from treatment (gas, taxi, car payment)
  • Rent, mortgage (housing provided through your treatment provider is not eligible)
  • Childcare

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 or terminate the granting relationship according to its own discretion.

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 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.

WithAll’s Recovery for All Program


Grant Requirements and Process for Funding 


WithAll’s Recovery For All Program provides living-expense grants to BIPOC* individuals seeking intensive treatment for an eating disorder. Grant funds are awarded to cover the cost of the applicant’s top financial stressor (groceries, transportation, rent/mortgage or childcare) for their full length of treatment up to 20 weeks.

Please carefully review the requirements and process below before applying.

You are eligible to apply if

  • You are a BIPOC individual with an eating disorder diagnosis from a medical provider.
  • You are in an intensive program treatment setting. An intensive program is defined as at least 9 hours a week and can include Intensive Outpatient, Intensive Day/Partial Hospitalization, and Residential Treatment.

Information needed to apply

  • If applying for rent/mortgage or childcare support, you will be asked to upload a bill, statement, lease, or letter showing the monthly or weekly fee for this expense. 
  • If applying for groceries or transportation support, you will be asked to upload a receipt or similar showing the need for this expense.
  • Name and phone number of your treatment provider who can verify your enrollment and level of treatment.
Eligible Requests
  • Groceries
  • Transportation to and from treatment (gas, taxi, car payment)
  • Rent, mortgage (housing provided through your treatment provider is not eligible)
  • Childcare

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 or terminate the granting relationship according to its own discretion.

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 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.
*
For the sake of brevity, WithAll uses the term BIPOC to indicate Black, Indigenous and People of Color. We acknowledge each individual’s right to self-identify and recognize that not all people for whom BIPOC is intended would choose to label themselves as such. WithAll understands the limitations of labels and embraces both the unique and shared elements of every individual’s lived experiences.
INTERNAL NOTE
This entire page is set to show conditionally if the application type on the front page is RSP Application Open = Yes, and it will not show for R4A.

Shannon - Page 2 will show as non-existent for R4A applications and may confuse people a bit, so if you can think of anything to include on this page for R4A I can have it show up conditionally instead of the calendar below.

Grant Award Process and Timeline


WithAll Granting Timeline


At WithAll, we want to walk alongside you through your intensive treatment journey. Therefore, grantees might be eligible for continued support beyond the first check. Grantees will be emailed one month after receiving their first check with a few quick follow-up questions to determine their eligibility.
INTERNAL NOTE
This entire page is set to show conditionally if the application type on the front page is R4A or if the RSP Application Open = Yes.
Recovery Support 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. 

***You must have a current diagnosis to be eligible for this grant.
Applicant Information
Alert
WithAll’s Recovery For All program is for those who individuals who identify as BIPOC*. If you do not identify as a BIPOC individual, please apply on the first of the next month for our Recovery Support Program. Thank you!

*For the sake of brevity, WithAll uses the term BIPOC to indicate Black, Indigenous and People of Color. We acknowledge each individual’s right to self-identify and recognize that not all people for whom BIPOC is intended would choose to label themselves as such. WithAll understands the limitations of labels and embraces both the unique and shared elements of every individual’s lived experiences.

INTERNAL NOTE
This entire page is set to show conditionally if the application type on the front page is R4A or if the RSP Application Open = Yes and the person notes they have a medical diagnosis.
Recovery Support 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
To receive a grant, we must have proof from one of your treatment providers that you are participating in an intensive treatment program.  Please complete the following:
Multiplies their stated weekly grocery bill by number of weeks of treatment. Will be compared later to the Auto-Calculate field to see which is lower number.
Multiplies their stated weekly transportation bill by number of weeks of treatment. Will be compared later to the Auto-Calculate field to see which is lower number.
Calculates $25 per week of for applicant and each additional household member. Main calculation only totals $50/week for applicant so additional $25/week is accounted for here. This field is a variable added to the Amount Auto-Calculated Total.
Calculates based on the weeks of treatment + expense category. In case of groceries adds the "Grocery Addl $25 per week Calculation" number. For Grocery and Transport will be compared with amount they requested to see which is lower.
Document Upload
Upload a PDF, Word Doc, JPG, etc.
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 recoverysupport@withall.org
INTERNAL NOTE
This entire page is set to show conditionally if the application type on the front page is R4A or if the RSP Application Open = Yes and the person notes they have a medical diagnosis.
Recovery Support 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 Recovery Support Program are reviewed on a case-by-case basis and final determination is made by WithAll.  
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.
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. 


You will now be directed to a Sign Now form. On this form you will be asked to authorize your treatment provider disclosing your enrollment in an intensive program. This step must be completed to have your application considered.