Ever Roll Fund logo EVER ROLL FUND
Mobility, made affordable.

Equipment Grant Application

The hospital saves your life. The right equipment gives it back - and it is the part almost nobody covers. This application is how we help you close that gap.

Before you start Your answers save in this browser
Before you start

A few things to have nearby

You do not need to send us tax returns, pay stubs, or bank statements. Tell us what you need, what insurance did, and what your situation is. We take you at your word.

Most people finish this in about 20 minutes.

  • A quote or invoice for the equipment, from the supplier or ATP who would provide it.
  • Your insurance decision - a denial letter, an explanation of benefits, or just what they told you.
  • The date of your injury and, if you know it, your level of injury.
  • Your supplier's contact information. If you are approved, we pay them directly, so we will need to reach them.

Your answers save automatically in this browser. You can close this page, rest, and come back to finish. Nothing is sent to us until you press Submit at the end.

Step 1 of 8

Are we the right fund for you?

Four quick questions. If any answer is "no," we will tell you right away rather than let you fill out a long form for nothing - and we will point you somewhere that may fit better.

Do you have a spinal cord injury?*

Traumatic or non-traumatic, at any level, complete or incomplete.

Please choose one.
Do you live in the United States?*

We fund people in all fifty states, D.C., and U.S. territories.

Please choose one.
Have you already been through insurance for this equipment?*

Meaning your insurer denied it, covered only part of it, or told you it is not a covered item.

Please choose one.
Is there a specific piece of equipment you are asking us to help pay for?*

We fund named items with a price on them, not general expenses.

Please choose one.
Step 2 of 8

Who is filling this out?

Anyone can start an application on someone's behalf. The person with the injury still has to sign it at the end.

Please choose one.
Step 3 of 8

About the person who needs the equipment

If you are applying for yourself, this is you.

Required.
Required.

This is how we will send our decision.

Enter a valid email.

We call if something on the application is unclear.

Required.
Required.
Required.
Required.
Enter a valid ZIP.

Applicants under 18 must have a parent or guardian sign.

Required.

So we address you correctly.

Step 4 of 8

Your injury

Enough for us to understand your situation. Answer what you know - nobody expects you to have your chart memorized.

An approximate date is fine.

Required.
Are you currently working with a therapist, ATP, or seating clinic?*

Not required to qualify. It helps us understand whether the item has been professionally fitted to you.

Please choose one.
Step 5 of 8

The equipment you need

This is the heart of the application. Be specific - the more precisely you can name the item, the faster we can act on it.

Make and model if you have it. "ROHO Quadtro Select cushion, 18x18" tells us more than "a cushion."

Required.
Required.

In your own words. This is the single most important answer on the form. For example: I cannot get up the ramp at my son's school without help. Power-assist wheels would mean I could take him myself.

Please tell us in a sentence or two.

From the quote.

$
Required.

Enter 0 if none.

$
Required.

Other grants, fundraiser, family. Enter 0 if none.

$
Required.

Our maximum grant is $5,000. You may ask for less than the full gap if you have another source lined up.

$
Enter an amount up to $5,000.
Remaining gap after insurance and other funding$0
Required.
If we could only fund part of this, would it still help?*

An honest answer here helps us stretch the fund across more people. It will not count against you.

Please choose one.
Step 6 of 8

Your supplier and your insurance

If you are approved, we pay your supplier directly against their invoice. We do not send money to individuals - that is how we keep every dollar traceable to a real piece of equipment for a real person. It also means we need to be able to reach whoever is providing your item.

The DME company, clinic, or retailer who would fill the order.

Required.

e.g. your ATP or rep

Enter a valid email.
Required.
Did you choose this supplier yourself?*

We ask because it matters to us that nobody is steering you. Ever Roll Fund never tells you where to shop or what brand to buy, and we do not accept anything of value from suppliers or manufacturers in exchange for referrals.

Please choose one.

Write "none" if you are uninsured. e.g. Medicare, Aetna, state Medicaid

Required.

Their reason, as best you understood it. "Not medically necessary," "capped benefit," "once every five years" - whatever they told you. If you have a denial letter, you can email it to us after you submit.

Required.
Have you applied to other funds for this item?optional

Applying elsewhere does not hurt your chances here. It helps us avoid double-funding the same gap.

Step 7 of 8

Your situation

We do not ask for tax returns, pay stubs, or bank statements. We ask you to tell us the truth about where you are financially, and we take you at your word. What you write here stays between you and our review committee.

A few sentences is plenty. Lost income, medical debt, a household living on one salary instead of two, savings already spent on the first round of equipment - whatever is true for you.

Required.
Required.
Required.

You may skip this. We ask only because it helps us direct the fund toward the people furthest from being able to self-pay. Skipping it will not disqualify you.

Are you, or is anyone in your household, an officer, director, employee, or immediate family member of Ever Roll Fund, Inc. or NeuroBridge Solutions, Inc.?*

Answering yes does not disqualify you. It means anyone connected to you steps out of the room while your application is decided. We are a small organization and we would rather say this out loud than have it discovered later.

Please choose one.
What you can hold us to

Our promises to you

We sell nothing. Ever Roll Fund does not sell equipment, does not take a commission, and is not paid by any manufacturer or supplier for sending you their way.

You pick the equipment and the supplier. We will never make an award conditional on choosing a particular brand, model, or vendor.

Your story is yours. Sharing it is optional and has no effect on whether you are funded. You can say no and still be approved.

We answer everyone. Approved or not, you will get a real reply from a person - not silence.

Step 8 of 8

Permissions and signature

May we share your story?completely optional

Donors give because of real people. If you are willing to be one of them, it helps enormously - but this is a genuine choice, and your answer is not visible to the people deciding your application.

Please confirm each of these*
Please confirm all five.

If you are applying for someone else, the person with the injury signs here. For an applicant under 18, a parent or guardian signs.

Required.

Today's date.

Required.

You will see a confirmation on screen and get an email within a few minutes. If you do not, write to inquiry@everrollfund.org - do not assume it went through.

Before you go further

We are probably not the right fund for this

Where to look instead

  • Not a spinal cord injury: your diagnosis-specific foundation is usually the fastest route, and many state assistive technology programs fund equipment regardless of diagnosis.
  • Outside the United States: we are only able to fund U.S. residents right now.
  • Insurance not yet submitted: file with your insurer first, even if you expect a denial. The denial is what unlocks most equipment grants, including ours. Come back to us with their answer.
  • No specific item yet: get a written quote from a supplier or ATP for a named item, then start again. We fund named items with a price on them.

If you think we have this wrong, write to inquiry@everrollfund.org and tell us. A person will read it.

Contact us instead
✓

Your application is in.

We have it. Nothing else is required from you today.

ERF-0000-0000

Write that reference number down. A confirmation email is on its way to your inbox.

Most applicants hear back within 30 days. If we say no, we will tell you why, and point you toward other funds where we can.

Back to Ever Roll Fund
How we review applications

There is no hidden scoring

We publish this so you know exactly what happens to your application and what we are weighing.

  • 1. We confirm you are eligible. Spinal cord injury, U.S. resident, a named item with a price, and insurance has already been through. Usually within three business days.
  • 2. We verify the quote with your supplier. We contact them to confirm the item, the price, and that they will accept payment from us directly.
  • 3. The review committee reads your application. We weigh how much the equipment changes your daily independence, how urgent the need is, how far the gap is from what you can cover, and whether other funding is available to you. We give particular weight to people in their first year after injury, when equipment needs peak and people are least able to fight for funding - but we fund people at every stage.
  • 4. We decide, and we tell you either way. Most applicants hear back within 30 days. If we say no, we will tell you why, and point you toward other funds where we can.
  • 5. We pay your supplier. Directly, against their invoice, with a copy to you. You take delivery from them as you normally would.
  • 6. We check in once, later. A few months on, we will ask how the equipment is working out. Answering is optional. It is how we learn whether we are doing this well.

What we do with what you tell us. Your application is read by the Ever Roll Fund review committee and no one else. We share your name, the item, and the quote with your supplier in order to pay them. We do not sell, rent, or trade your information, and we do not share it with equipment manufacturers. Health information you give us here is not covered by HIPAA, because we are a grant fund and not a healthcare provider or insurer - we protect it because it is yours, not because a statute requires it. Full details in our Privacy Policy and Terms of Service.

Ever Roll Fund, Inc. · Florida nonprofit corporation · EIN 42-3511117 · Serving people with spinal cord injuries in all fifty states.
501(c)(3) application pending with the IRS - determination letter available on request. Grants are made at the discretion of the Ever Roll Fund board. Submitting an application does not guarantee an award.