Aid Program — Windy Willow Foundation

Windy Assistance Fund Application & Criteria

Please carefully read our instructions and criteria below. The Assistance Fund application can be filled out via the form below OR downloaded.

Windy Willow Foundation Mission

“Windy Willow Foundation is an organization working to provide access, advocacy, and action for mental health initiatives. The foundation is dedicated to destigmatizing the root challenges involved in mental health and wellness. Through intentional support, a community-oriented focus, and common cause, we push forward One Day at a Time.”

Assistance Fund Application

Windy Willow Foundation was founded in early 2021 as an affiliate nonprofit of Windy Willow Co., a brand supporting mental health awareness initiatives. The foundation supports adolescents & younger adults through various means- one of which being our assistance fund. We understand there are gaps between mental health services and coverage, therefore, we work to support those seeking help. Our foundation is accepting applicants through our website to help cover specified situations and individuals with financial aid. Please see below criteria and instruction to apply to our program.

Criteria for Eligibility

Our age limitation is geared towards children, younger adults, and post graduate/later twenties; but not limited to- case by case evaluation will be conducted by the review team.
Need immediate assistance with financial aid not covered by insurance or unable to pay out of pocket
Specifically for a mental health service including therapy, consulting, clinic or other health actions related services to:
- mental health crisis
- depression or anxiety
- suicide prevention guidance/therapy
- trauma therapy
- and/or any other behavioral service (please detail in application)
Applicant should not be receiving other forms of financial aid OR detail why additional aid is requested

Instructions

Complete the following application and please be detailed in the following categories:
Applicant should detail why financial aid funding is requested as well as the dollar amount they are seeking and other supporting facts for the committee to review
Applicant should explain (to the extent they are allowed/willing) their situation
Applicant will provide the insurer or business that is requesting payment, where payment from the foundation will be direct to processor with prior verification and communication by the requester of payment
Attach supporting documents to application
Application submission may either be processed through the website form or the downloadable application sent to david@windywillowfoundation.org .
Any additional questions or comments can be sent to david@windywillowfoundation.org .

Aid Program Application

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Who is filling out this application?

If filled out by other than self, please specify (must be legal guardians of applicant if under 18 years of age):

Explanation of Situation:

Dollar Amount Requested & Reason for Request:

Other supporting details for committee to review:

Contact information of insurer/business requesting payment:

Disclosures

1) The phrases and circumstances of this Agreement are completely confidential between Windy Willow Foundation and the applicant, recipient of aid, and all others involved in the application process and shall not be disclosed to anybody else. 2) Financial assistance will be provided with the use of said funds to be specified by Windy Willow Foundation. 3) The undersigned further agree(s) to return any unused funds immediately to Windy Willow Foundation so that those funds can be utilized by the organization to benefit other families. 4. The undersigned acknowledge(s) and agree(s) to maintain records that will be made available to Windy Willow Foundation upon reasonable request, detailing the expenditures made from the funds provided by the organization. 5) Windy Willow Foundation reserves the right to distribute funds at its sole discretion. Windy Willow Foundation may pursue restitution for grants if it is determined that the information submitted on the application is false. 6) I have read the guidelines for financial assistance and I declare that the information furnished on this application form, including attached sheets, is true and correct to the best of my knowledge. 7) When delegating a grant, Windy Willow Foundation is not advocating for the specific health care providers or medical equipment suppliers, but only providing the funds to enable you to access the services and equipment. You acknowledge and agree that accepting a grant from Windy Willow Foundation is strictly voluntary. Furthermore, you agree that you will be responsible for any choices you make regarding the medical care, equipment or supplies, or for the failure, malfunction, repairs or ongoing maintenance of any equipment obtained as a result of the grant of funds. Any disclosure in violation shall be deemed a breach of this Agreement. By checking this box, you agree to these terms. The undersigned are the parents or guardians of the child (if applicant is under 18).

Agree

E-Sign Consent to Disclosures

First Name

Last Name

How did you hear about us?

PDF Form

*Supporting documentation should be uploaded/attached and sent with application either via online submission or email to david@windywillowfoundation.org

Windy Assistance Fund Application & Criteria

Resources