David Shea Memorial Patient Support Fund

The David Shea Memorial Patient Support Fund beneficiary must be someone living with Scleroderma in one of the four Atlantic provinces (NS, NB, NL, PEI). Expenses must be incurred on behalf of the beneficiary and supported by receipts. Financial support from the fund is a maximun of $1,000 per year, per applicant. Please complete and submit the form to apply.

Full Name

Phone Number

I confirm that I am living with scleroderma.

Mailing Address Line 1

Mailing Address Line 2

Postal Code

Province

Please indicate the type of expense being submitted for reimbursement and include a copy of the receipt(s) by using the link provided below

Please upload any relevant receipts

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