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 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 download the appropriate form below:
Form #1 – Apply for yourself >
Form #2 – Apply for someone else >