Emergency Support Program Eligibility – The Ree Wynn Foundation

Complete the application to determine if you are eligible for assistance. Proof of diagnosis and bills for vendors that require payment will need to be uploaded to complete the application process. To speed up the process, please have these documents ready before you begin.

First Name

Last Name

Email

Phone

Are you a U.S. Citizen?

Yes

No

Have you received Emergency Support funds from The Ree Wynn Foundation in the past 12 months?

Yes

No

Have you been diagnosed with TTP or are you a caretaker of someone diagnosed with TTP?

I have been diagnosed with TTP

I am a caretaker of someone diagnosed with TTP

Neither

Applicant doctor/facility name and phone number

Patient full name

Patient doctor/facility name and phone number

Complete if you are applying as a caretaker.