Application for Matt’s Place
Applicants must provide:
• Previous years’ tax returns
• Please list all assets including estimated value of property owned, vehicles
• Please provide copy of savings account
• Proof of incomes in monthly statement
Below is the application for applicants. Priorities of being eligible to live in the home are:
• ALS diagnosis
• Middle to end stage of life
• Middle to fast progression
• Family with small children get first priority, with low income, those who do not own their home, or have no income to remodel home.
This is a first come first serve home. The home will be utilized to those willing to go through the application process.
If a person with ALS passes away while living in the home, the family members will have 45 days to vacate the property for another family to move in. The house must be left in a reasonable cleanliness, and any repairs needed must be put in writing before vacating property.
Stage of diagnosis (partial paralysis, compromised respiratory)
Please provide FVC number as well as details of loss of function
Other Health Conditions – please specify
Do you have a tracheostomy, or do you plan to have a trache in the future?
How will living in this home affect your plans for extending your life?
Do children currently live with you? If so, please provide ages.
Does Spouse work outside the home? If so, what is their annual income?
Was spouse forced to quit working to provide care?
Will you be financially responsible for any damages incurred by pets?
Has current home been modified to accommodate needs?
If so, what has been done for the home and how much were the costs?
Did you pay for costs out of pockets?
What are plans with current home if you are accepted into the Matt’s Place Home?
Please specify any other income sources not listed above
A condition of grant approval is allowing Matt’s Place Foundation to use the name of the recipient (first name/last initial acceptable), project information/cost, and project photographs for promotional material. If your grant is approved, do you expressly authorize Matt’s Place Foundation to use your name, project information and photographs for future internet and print promotional materials?
The information contained in this application is for internal foundation purposes only.
Founded in 2015, Matt’s Place Foundation is a 501(c)(3) charitable organization created to assist PALS (People with ALS) and their families during their battle with ALS. Its ultimate intention is to provide hope, housing and assistance to families dealing with the ailments of motor neuron disease like ALS, including Parkinson's and SMA. We hope to raise funds through sales of Matt’s Place Merchandise, fundraising events, and also by accepting cash and in-kind donation which will be used for the resources, technology and assistive items PALS may need. Through collaborating with other ALS foundations and like-minded organizations, we also hope to bring greater awareness to ALS, and the need for better treatment options and at some point a cure.