The mission statement of JoshProvides is to improve the quality of life for those living with epilepsy or other seizure disorders. In addition, Josh Provides strives to eliminate the stigma sometimes associated with epilepsy. To learn more about our funding priorities, please visit the page How JoshProvides Can Help.
Download the application below if after reviewing the information below, you determine you need financial assistance for:
- Seizure detection devices (or other technology recommended by the applicant’s neurologist)
- Transportation expenses to and from home, school, medical services or employment
- Medical services
- A seizure response/detection dog
JoshProvides has established procedures and guidelines for requesting financial assistance for an item that falls within the funding priorities of JoshProvides. Applicants acknowledge that the distribution of financial assistance is entirely discretionary by JoshProvides. There is no assurance that a request will be approved (in whole or in part or not at all). A request in one instance shall not be considered the basis for approval or denial in a subsequent request for financial assistance.
Request for Support Group or Education: If you are someone with epilepsy or are a parent, family member, guardian, or caregiver who desires to organize a support group or educational program, send a letter of intent, a budget, and a plan of organization for review by JoshProvides. This information can be emailed to Info@JoshProvides.org.
Request for Financial Assistance
These are the minimum guidelines an applicant must satisfy in order to be considered for financial assistance:
- Eligibility Determination: To determine eligibility for assistance from JoshProvides, the applicant must meet the following minimum standards:
- Applicant (or applicant’s parents/legal guardian) has insufficient income due to being unemployed, suffering a severe loss of income or lack of income, or due to the excessive nature of epilepsy-related needs.
- Applicant must be diagnosed by a licensed physician as having epilepsy or other seizure disorder.
- The application must include detailed information regarding the amount requested and the purpose of the funds.
- Applicant must certify that the product or service being requested is necessary to monitor, control and/or reduce the applicant’s seizure, and has been recommended by the applicant’s neurologist.
- If applying for assistance for transportation, the applicant must certify that he/she has no means of transportation to and from home, school, work, or medical services without using public or private transportation services.
- If applying for a monitor or other seizure detection device, the applicant and manufacturer of the desired device must certify that the device is necessary for the applicant to monitor, control and/or reduce seizures. This is evidenced by including the completed and signed Certificate of Medical Necessity.
- By submitting an application, the applicant (or applicant’s parents/legal guardian) certifies that he/she does not have sufficient resources to pay for the service or item being requested and that financial assistance is not available from any other source (including insurance, government funded programs such as Medicaid or Medicare Part D, community resources such as those offered through the United Way, or patient assistance programs offered by pharmaceutical companies).
- No portion of the funds from JoshProvides are permitted to be used for administrative purposes.
- The applicant (or applicant’s parents/legal guardian) certifies and acknowledges:
- JoshProvides does not warrant or endorse the product and/or service requested by the applicant.
- JoshProvides is not the provider, manufacturer, distributor, agent, affiliate, owner, representative, or consultant for any provider of the product and/or service requested by the applicant.
- An application will only be submitted after the applicant (or applicant’s parents/legal guardian) conducts the applicant’s own due diligence regarding the use and potential benefit of the product and/or service being requested. This is done without any endorsement or recommendation by JoshProvides.
- JoshProvides has no responsibility or liability to or for the applicant’s use or benefit of any requested product and/or service.
- If an application is approved by JoshProvides, the responsibility of JoshProvides is only to provide financial assistance, in whole or in part, for the product and/or service requested by the applicant. It is the sole responsibility of the applicant (or applicant’s parents/legal guardian) to communicate and consult directly with their attending neurologist and the provider of the product and/or service being requested to determine that the purpose and use of the product and/or service being requested will be a benefit to and is in the best interest of the applicant.
- JoshProvides reserves the right to approve or disapprove any request for assistance, in whole or in part.
- The applicant (or applicant’s parents/legal guardian) will provide a photo of the applicant with the application. This submission constitutes consent to JoshProvides use of any and all photos and testimonials provided by the applicant for JoshProvide’s use on the website, social media platforms, marketing materials, or otherwise without any further obligation to secure the applicant’s (or parents/legal guardian) consent. All additional documents attached to the application will be deemed incorporated in the application
By downloading, completing, signing and submitting an application, the applicant (or parents/legal guardian) agrees to all of the statements above and the following:
JoshProvides has no responsibility or liability to or for the applicant’s use or the benefit of the product and/or service being requested. The applicant (or parents/legal guardian) assumes all risks and consequences from the use of the product and/or service requested and releases JoshProvides and its board of directors, officers, sponsors, agents, employees, volunteers and affiliates from any responsibility and liability, of any kind or nature, whether foreseen or unforeseen, relating to applicant’s use of or benefit received (or not) from the product and/or service requested. Application approvals will be made on an as need basis and the approval will be communicated to the applicant and/or the merchant provider of the product and/or service being requested.
If you accept all the terms and requirements as explained on this page, please proceed to download complete and execute an application. All signatures are required.
A completed and signed/executed application and photograph should be scanned and emailed to Info@JoshProvides.org. If you are unable to return the application electronically, a hard copy photograph can be mailed to:
JoshProvides Epilepsy Assistance Foundation
Attention: Client Services
5428 Sundew Drive
Sarasota, FL 34238