Continuation of Care Grant Application PKU News, How Much Phe, and Cook for Love realize that the COVID-19 Pandemic has had a devastating impact on many families in our community. We are here to help. To provide direct support when you need it most, we applied for and received a $20,000 grant from the Global Genes Foundation Continuity of Care RARE Patient Impact Grant program, and raised matching funds from private donors. Horizon Therapeutics and Homology Medicines have also generously supported the program to allow us to provide direct support to the low-protein community, in the form of: Gift certificates in the amount of $150 for low-protein foods Complimentary one-year subscriptions (or subscription extensions) for HowMuchPhe.org These grants are designed to help you maintain the same level of health & diet maintenance as before the pandemic. The grant is governed by the following requirements: One grant per household Indviduals and families managing any metabolic disorder that requires a low-protein diet are eligible The low-protein medical foods grants are reserved for those who do not have coverage under their insurance (or any other program) for low-protein medical foods. Individuals who only have coverage for medical FORMULA are eligible for this grant. Grants are limited to those in the United States, Canada, and their territories Priority for all grants is given to those who are experiencing financial hardship due to the COVID-19 Pandemic. We cannot guarantee funds to all who apply. PLEASE NOTE: The response has been overwhelming and funds are limited. We will continue to accept applications even as the program reaches capacity. You may still apply and grants will be issued as long as funds are available. Please check below to proceed with the application process* I understand and agree to these terms Your Name* First Last Your Email Address* Your State/Territory*Please selectAlabamaAlaskaArizonaAlbertaAmerican SamoaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOregonOntarioPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonArmed Forces AmericasArmed Forces EuropeArmed Forces PacificMetabolic Disorders Requiring a Low-Protein Diet in your Household*PKUMSUDTyrosinemiaHCUUCDOrganic AcidemiaOtherIf other, please specify*Have you used How Much Phe?*I'm a current subscriberI'm a former subscriberI've never used it but would like toI'm not interested in using itPlease enter the email you use to log into HMP* We'd love to know why you haven't used HMP or aren't interested in using itFormer subscriber? Let us know why!Does Your Health Insurance Provide Any Coverage for Low-Protein Modified Foods (LPMF)?*This does not refer to coverage for formula, but for other medical foods (bread, pasta, Cambrooke items etc).Yes, we have some coverage for LPMFNo, we do not have any coverage for LPMFPlease give us a little information about how the COVID-19 Pandemic has affected your family. These grants are designed to provide to support to those whose financial situations have been directly affected by the conditions surrounding the pandemic. Any details you can provide will help us understand your needs.*May we use excerpts of your quote about the affects of the pandemic when we report grant results?No identifying information will be used (names, locations, and other details will not be included). Yes This grant is being provided through the Global Genes Foundation Continuity of Care RARE Patient Impact Grant, and carries specific reporting requirements. If you are selected as a grant recipient, you will need to provide the following information on a separate form in order to receive your grant. You will not need to provide your name or any contact information along with this data, and no personal information will be provided to Global Genes or any other entity along with this information. This helps Global Genes understand who they are reaching with their support. Total people living in household Rare disease(s) in the household Total people in the household living with rare disease(s) Approximate gross annual household income in US Dollars Language most commonly spoken in the house Age(s) of the person with the rare disease(s) Gender(s) of the person with the rare disease(s). Race of the person(s) with the rare disease(s). Ethnicity of the person(s) with the rare disease(s).