Loading...

Please wait...

California Rehabilitation Foundation
California Rehabilitation Foundation

This form may be completed by any individual who seeks assistance with items needed to enable independence that are not deemed an urgent safety need. California Rehabilitation Foundation may not be able to assist every individual who applies for assistance. Only complete applications will be reviewed.

Qualifications

    Select all that apply *


    If applying for home modification(s) *


    If applying for sports, leisure, and recreation equipment *

01

Contact Information

02

Qualifications

03

Demographic Information (optional)

04

Request

EIP grants are awarded for up to $7,000 (limit of one grant per applicant every two years)

Partial Payments

If funds are for partial payment, please indicate the following

05

Financial Information

06

Referral Source

07

Relationship with California Rehabilitation Foundation

Partner with Us

During the process of recovery, one of the most important things we can do is show others they are not alone. Each day, we are inspired by the stories of individuals who demonstrate strength and resilience during life’s most difficult challenges. By partnering with the Cal Rehab Foundation, you can bring the gifts of hope, healing and independence to people with physical disabilities.

California Rehabilitation Foundation

2070 Century Park East
Los Angeles, CA 90067