Get Spin For Kids Funds Application Form - Altru Health System - Altru

This guide provides a comprehensive overview of how to complete the Spin For Kids Funds Application Form designed for children with special needs. By following these step-by-step instructions, you can ensure your application is complete and submitted correctly.

Follow the steps to successfully complete your application.

1. Use the ‘Get Form’ button to access the Spin For Kids Funds Application Form, which will allow you to open it in a convenient online editor.
2. Fill out the patient information section, including the patient's name, birth date, diagnosis, and contact number. Ensure that you provide accurate and up-to-date details.
3. Complete the parent or guardian's information section. If the address is different from the patient, specify the alternative address clearly.
4. Indicate the number of persons in your household, specifying the count of adults and children under 18.
5. Provide the medical information required, including the primary physician's details, any other involved physicians, and details of therapists if applicable.
6. Fill in the financial information section, ensuring to attach the most recent federal tax return Form 1040 as required.
7. Input the primary and any additional insurance details with their corresponding policy numbers.
8. In the funds requested section, list the type of therapy, services, or equipment along with the costs, amounts covered by insurance, and the total amount of funds you are requesting from Spin For Kids.
9. Attach all necessary documentation, including descriptions of requested therapies, proof of costs, prescriptions, supporting documentation, and any insurance correspondence.
10. Review your completed application for accuracy and completeness before submitting. Make necessary adjustments if any information seems incorrect or incomplete.
11. Save the changes, and download a copy of the form. If needed, you can print or share the document as instructed.

Complete your Spin For Kids Funds Application Form online today to ensure your child receives the necessary support.