Equip For Funding Grant Application

Please read all questions and answer them completely. We will consider only complete applications. Application deadline: Monday, October 5th, 2025. Applicants who receive an Equip For Funding Grant will be notified by the grant committee by November 10, 2025. The next application period will be in 2026. *Our program is currently only available to those who are 21 years of age and older and who currently reside in the state of Maine.

Please provide your contact information, so we can reach out to you if we need clarification regarding this application.

Our funding goes toward adaptive equipment, assistive technology, therapy treatment and/or any other compulsory (or essential) item not cover by insurance or any additional funding resources. 

In order for us to best serve you, we'll need to know a bit more about why you are applying.

Funds are rendered directly to the business. Please provide accurate business/organization name below. This would be the name of the business from which you are trying to purchase equipment, therapy, or assistive technology.

Have you reached out to other organizations for help with this request? If you have and they have agreed to contribute, please list the name(s) and the total amount combined this or these other sources are contributing.  

Our program is built to help those in need of assistance with acquiring equipment, technology, and therapies they otherwise would not gain access to. This part of the application is incredibly important. We ask that you please describe the request in detail, what service equipment or technologies are you requesting assistance with? Please also provide us with information about your need. Why are you asking for it? How will it help you and or improve your quality of life?

In order to help contribute to your request, we need to have the following documents:

1. If you have been denied coverage for this item by insurance or MaineCare, please include that denial letter.

2. Please include an estimate/quote for the equipment or service from your vendor.

3. We will also need a letter of recommendation from the applicant's Physician/Therapist/Healthcare Professional documenting the applicant's need for the requested service, equipment, or technology. This letter must speak to the specific need of the item/service requested from the Equip For Funding Grant, the more information provided in this letter the better. 

AUTHORIZATION

For the person(s) providing consent:

• This consent has been made freely, voluntarily, and without coercion.

• I understand that the information indicated is protected by law and cannot be released without my written permission, unless otherwise specifically permitted by law.

• I understand that I have the right to review information and material released.

• I understand that I have the right to refuse to disclose the following specified information (Specify this information in the section below).

• This authorization is valid for a period of one (1) year from the date of signing, but I also understand that I have the right to revoke this authorization in writing at any time.

• I understand that if this information is disclosed to a third party, the information may no longer be protected by the federal or state privacy laws and may be redisclosed by the person or entity that receives this information.

• Finally, I understand that if I am being considered for an Equip For Funding Grant, more information may be needed prior to the final decision so please respond promptly to follow-up questions.