Apply

Want to apply for assistance?

1. Determine what assistance you need. 2. If the assistance is for a prosthetic device, then obtain a prescription and an itemized estimate. (Please understand that any funds given for these items will be made directly to the prosthetic company.) Authorize the company to allow our foundation to contact them for verification purposes only. 3. Gather your personal information, such as: a. Name, address, phone number, date of birth b. Family gross income c. Disability information d. Health Insurance Information e. Information to justify your request for financial assistance. (We would like a justification statement from you stating how you feel the device or other requested items will help you to . . get a job, do better in school, enhance your independence, etc.)

Download Application

Once you have the information required, you can download the application below to apply for assistance:

Eligibility

Must be a current or graduating student from Hemet High School AND Currently have diabetes OR Be an amputee in need of financial assistance towards the purchase of a prosthetic device OR An organization needing financial assistance to help offset the cost of educational information on diabetes and/or disabilities.

Submit Application

If you meet the above eligibility requirements, you can submit your completed application form below, or email it to: Application@juliahjensen.org. Our board of directors will review all submissions and contact you once a determination has been made.