REQUEST FOR ASSISTANCE APPLICATION FORM
Wake Up & Lace Up is a 501(c)(3) non-profit organization that provides financial assistance to residents of Eastern Montana who have incurred unreimbursed medical and out-of-pocket expenses (i.e. transportation, lodging, meals, etc.) associated with the treatment of a serious medical condition.
If you would like to request assistance for yourself or a family member or friend, please click this link to download and complete this PDF application.