Springbrook HELP Committee Fund Application

Each year, the Springbrook Foundation sets aside a portion of its Annual Fund to support people receiving services through Springbrook Partners and Affiliates. Through the HELP Committee—a volunteer group of Springbrook and affiliate staff—financial assistance is provided to help meet essential needs that cannot be covered by other resources.
Assistance may be awarded for health and safety needs, enrichment activities, equipment that supports independence, and holiday assistance. The committee reviews all applications to ensure funds are distributed fairly, responsibly, and in alignment with the Foundation’s mission. Funding availability and award amounts vary based on need and available resources.
The HELP Committee exists to promote health, safety, and quality of life for people with intellectual and developmental disabilities.

Eligibility

Funds may only be used to support the person receiving services through Springbrook Partners and Affiliates.
People receiving services, a family member, or a member of the individual’s support team may complete an application

General HELP Review Timeline

Applications are reviewed on the first and third Thursday of each month.
Applications must be completed in full to be reviewed.

General HELP Approvals

The requester will be notified of approval, denial or if more information is needed.
Approved check requests are printed and mailed by the Friday following the committee meeting.
- Approved Amazon or Walmart orders are placed after notification, and shipping/delivery information is shared with the requester.

Holiday HELP Request Timeline (funds are determined based on the number of eligible requests)

Check requests must be completed by the second Friday of October
Requested items from Amazon or Walmart must be completed by the second Friday of November.
- For Amazon/Walmart requests, the HELP Committee application AND supplemental form must be completed to successfully fulfill approved orders.

Holiday HELP Approval

Notification to the requester regarding the approval/denial of a check request is completed last Friday of November
Notification to the requester regarding the approval/denial of Amazon or Walmart requests first Friday of December.

Please note:

Gift cards cannot be purchased with funds from the HELP Committee
If previous awards were granted for which receipts were not returned, any new applications may not be considered.
Applications will not be considered if there is lack of documentation to show that other resources/supports denied financial assistance.

If you have any questions regarding funds, distribution, or eligibility, please contact:

Helpcommittee@springbrookny.org
607.286.7171, ext 271

Application Date:*

Date

Name of person you are requesting funds for (if self, type your first and last name): *

First NameLast Name

Person's age:*

Person's primary Springbrook affiliate program:

Name of person completing the form*

First NameLast Name

If you are a care manager or a Springbrook employee, please indicate your job title (i.e., CCM, Residential Manager)

Your email Address:*

example@example.com

Your phone number:*

Area CodePhone Number

Extension if applicable

Extension

Your affliation to the person for whom the HELP Committee funds are being requested:

Please provide the justification for this request to the HELP Committee.*

Describe other attempts made to meet the person’s/your needs (i.e., DSS, Family Resource Network, Catholic Charities):*

Date of request from other agency

Date

Please share a screenshot/download of the denial or rejection from other organizations to obtain the funds (i.e., Insurance, Family Resource Network, Department of Social Services, Catholic Charities). You can also share the policy that verifies why another agency will not approve the requested funds or items.

Browse Files

Is this a request for a direct order from Amazon or to receive a check?*

AmazonCheckWalmart

Name of person receiving shipment:*

First NameLast Name

Location where items will be shipped: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Amount of HELP Committee funds requested: *

Purpose of Funds

Other Purpose of Funds*

Was this cost/item previously covered by another organization in the past ? If so, please share the year and which organization. If not, write N/A.*

Is this a cost that was previously covered by FSS?*

YesNo

Please attach a screenshot or download of the cost/bill/invoice/estimate. This will assist the committee in making their decision for approval.

Browse Files

* Please avoid having the check made directly to the person receiving services because it is reportable and may impact their benefits for that month.

If the request is granted, who should the HELP Committee make the check payable to?*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please Note:

The information above is accurate to the best of my knowledge. I understand that receipts are required to be emailed to the HELP Committee (HelpCommitee@springbrookny.org) within 2 months of receipt. If there is change from the transaction to return to the HELP Committee, it must be provided by dropping it off at the Springbrook Foundation (105 Campus Drive, Oneonta, NY 13820) or by mail. I understand that failure to submit receipts may affect the consideration of my future applications.

If you have any questions regarding funds, distribution, or eligibility, please contact:

Helpcommittee@springbrookny.org
607.286.7171, ext 271