Application - BELIEVE – Stroke Recovery Foundation

We accept applications on an ongoing basis. Before applying, please review the eligibility guidelines.

You may fill out the application to receive financial assistance to continue out-patient rehabilitation by printing the application out and emailing it to Believe@BelieveSRF.org or by mailing it to:

BELIEVE – Stroke Recovery Foundation
14460 Falls of Neuse Rd Ste 149-227
Raleigh, NC 27614

Once your application is submitted, we will contact you to let you know if you are eligible to receive funds.

Applications are reviewed on a first-come, first-served basis as funds are available.

BELIEVE – Stroke Recovery Foundation reserves the right to deny any incomplete or falsified application. By submitting an application, you certify that you have reviewed the eligibility requirements and that you are eligible for assistance.

Online Application Form

Financial Assistance for Continued Out-Patient PT, OT or SLP

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Race
Gender
Are you a U.S. citizen?*
- Yes
- No
Comments
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