2025 Support Group Stipend Award
The FARE Recognized Support Group Stipend Program was developed to help fund the operational expenses of support groups across the country. Operational expenses include, but are not limited to: Website Maintenance; Virtual Platforms; Materials and Supplies; Marketing and Advertising; Printing; Speaker Honoraria; Annual Subscriptions; etc. Please complete this application by Monday, March 3, 2025.
Support Group Leader Information
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Adivisor Information
Medical Advisor Name
*
Medical Advisor First Name
Last Name
Medical Advisor Email
*
example@example.com
Medical Advisor Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Support Group Information
Support Group Name
*
Area Served (city/region and state)
*
How many years has your support group been FARE-Recognized?
*
Fewer than 1
Between 2 and 5
Between 6 and 10
More than 10
How many many members are in your group? (appoximately)
*
How does your support group meet?
*
Online
In Person
Hybrid (online and in person)
How often does your group have meetings?
*
Weekly
Monthly
Quarterly
Other
What types of community outreach does your support group engage in?
*
Stipend Award Request Information
Stipend Amount Requested? (up to $500)
*
Please submit a completed W-9. This is required by FARE for Payment.
*
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Please explain how you intend to use this stipend award, including amounts: (we are looking for something like a simple itemized budget)
*
Signature
*
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