Funding Application – Light for Levi Inc.

Funding Application

Step 1 of 4

Eligibility Criteria:

Must have a documented brain injury, which could have occurred either before or after birth, verified by a doctor or other professional healthcare provider.
The individual affected by the injury must be 21 years of age or younger at the time of application.
Must be a resident of the United States
The grant will be awarded only once per individual
Applicants must not be a member or immediate family of the Light for Levi Foundation, in the following roles: Directors, Employees, Founders.

Please note that these eligibility requirements must be met to be considered for the Light for Levi Foundation grant.

Child's Information

Name(Required)

First Last

Date of Birth

Parent/Guardian Information

Name(Required)

First Last

Phone Number

Email Address(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country