1. Contact Information First Name * Last Name * Phone Number * Email * Street Address * City * Postal Code * 2. Expense Receipts Attach a copy of the receipt you are requesting financial reimbursement for. Expense Receipts Add a new file * Files must be less than 200 MB.Allowed file types: gif jpg jpeg png pdf doc docx. 3. Support Documentation People with lung disease and/or primary care givers applying for Caring Breath’s will require a letter of support from a health care provider. Medical: Health Care Provider Support Letter Attach a copy of the documentation from a health care provider stating that you or someone you are caring for requires the above request. Your health care provider can also fill out the fillable PDF template below and email it to us directly at caringbreaths@sk.lung.ca. Some examples of health care providers that can provide a letter of support includes but is not limited to; Doctors, Nurse Practitioners, Nurses, Social workers, Physiotherapists, Pulmonary Rehabilitation Exercise Therapists, Certified Respiratory Educators, Respiratory Therapists, Pharmacists etc. Please include the following information in your letter of support: Identify your role in care. On whose behalf are you writing the letter of support for? Provide the rationale for the applicant to apply for the Caring Breath’s program. Provide the rationale why the applicant would benefit from the Caring Breath’s program. Fillable Template Letter of Support for Health Care Professionals - click here Radon Mitigation: Results of Long-Term Radon Test Prior to Mitigation Provide a copy of your long-term (minimum three months) Health Canada approved radon test results that prompted mitigation work. Support Document Add a new file * Files must be less than 200 MB.Allowed file types: gif jpg jpeg png pdf doc docx. 4. Income Verification What is your net disposable income? (monthly income after taxes) Choose range that applies to you. income * income * $500 or Less $500 - $1000 $1000+ 5. Other Financial Support Select any other organizations you have received financial support from to help cover related costs. Other Supporters Kinsmen Foundation - www.telemiracle.com Saskatchewan Aids to Independent Living (SAIL) - www.saskatchewan.ca Good Hearts Foundation - goodheartsfoundation.blogspot.com David Foster - davidfosterfoundation.com SaskAbilities - www.saskabilities.ca (Radon Reduction) Government of Saskatchewan’s Home Renovations Tax Credit - www.saskatchewan.ca Other... Other Supporters Other... Optional: Other Information You may use this field to provide any other information you feel is relevant or important to your application. Other Info If you have any questions about our Caring Breaths program, please email caringbreaths@lungsask.ca Leave this field blank
