To request equipment worth over $200, use this form. If your requested equipment is worth less, use the short form.

If you’d rather mail us your application, you can download this printable version.

In addition to the form below, we will need:

  • a letter from your healthcare provider with the relevant diagnosis, specific request for funding, and any other important information
  • proof of income (pay stub, last year’s 1040 or W-2, or a letter from employer).

You can email this information to foundation@mmtherapycenter.com or fax to 406-797-5008.

List anything that will make you safer or more independent in travel, communicating, learning, work, or social and recreational activities.
If the amount requested is less than $200, don't use this form. Use the short form.
This does not include the expense for which you're requesting funding.
Including you.
If you are using community service hours to contribute to the cost of your equipment, please reach out to us beforehand. You can email us at foundation@mmtherapycenter.com or call us at 406-396-4130.
This question is for grant-reporting purposes. It will not be considered in deciding whether or not you receive funding.
What's the best way to get in touch with you?
We'll need a letter from your doctor or other healthcare provider with the relevant diagnosis, specific request for funding, and any other important information. This can be emailed to foundation@mmtherapycenter.com or faxed to 406-797-5008.

Thanks for applying! We can’t wait to work with you.