Arizona Financial Support Program

Financial Support for People living with Parkinson’s in Arizona

The APDA Arizona Chapter is pleased to offer a Financial Support Program which provides financial assistance to people with Parkinson’s disease (PD) and their families who reside in the state of Arizona. Approved applicants will be eligible for up to $300 once per calendar year (January-December). Funds may be used for programs, services, and activities designed to improve quality of life.

Applications are reviewed on a rolling basis and applicants will be notified within sixty (60) days of receipt. Awards are made on a first-come basis and are based on the availability of funds. The program is subject to change and/or discontinuation with limited notice.

Eligibility Guidelines:

To qualify for this Financial Support Program, the applicant will:

Complete and submit the below application.
Attest to having a diagnosis of Parkinson’s disease or Parkinsonism.
Understand this program is intended to support people with Parkinson’s disease or Parkinsonism who are in need of financial assistance.
Reside within Arizona.
Reside in the community, not in a rehabilitation center or long-term care, or skilled nursing facility.

Please call 928-200-1192 or email apdaaz@apdaparkinson .org with any questions or if you have any issues with submitting the application.

Arizona Financial Support Program Application

Applicant Name(Required)

First Last

"Applicant” is the person diagnosed with Parkinson’s disease or Parkinsonism.

Choose either primary or secondary contact(Required)

Primary Contact

Secondary Contact

Year of Diagnosis(Required)

Year of Birth(Required)

Care Partner Full Name (if Applicable)

First Last

Choose either primary or secondary contact

Primary Contact

Secondary Contact

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Applicant's Phone(Required)

Applicant's Email(Required)

Care Partner's Phone

Care Partner's Email

Total Amount Requested:(Required)

Total cannot exceed a one-time $300 payment per calendar year.

Have you ever applied for this program or any other related financial award from APDA?(Required)

Yes

Applicant Consent:(Required)

I understand, accept and acknowledge the terms of the eligibility guidelines; that the applicant has a diagnosis of Parkinson’s disease or Parkinsonism; that any additional expenses beyond the approved amount will be the applicants sole responsibility; that the applicant is solely responsible for choosing the provider for the programs, services and/or activities; and that APDA assumes no responsibility for additional expenses and/or for the choices of provider/services/activities.

Release of Liability: On behalf of myself, my heirs, successors, and assigns, I hereby forever release, indemnify, and hold the APDA, its officers, directors, employees, and agents, harmless from and against any and all injuries, deaths, claims, liabilities, losses, damages, costs, and expenses arising from or in any way related to, my participation in this program. I intend this release to be effective, regardless of whether the claim of liability is asserted in negligence, strict liability in tort, or other theory of recovery.

Digital Signature (Applicant or Care Partner)(Required)

By entering my digital signature, I am confirming that I agree to the applicant consent and release of liability as indicated above and that I am requesting financial assistance from APDA.

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