Community Assistance Fund

SUICIDE PREVENTION HOTLINE: 1-800-273-8255

CRISIS HOTLINE: 1-800-991-5272

NAMI NATIONAL HELPLINE: 1-800-950-6264

The work we do every day centers around helping individuals and families living with mental health conditions. People don’t have access to the medicine they need because they cannot afford them. To make a real impact in their lives, we want to ease the financial burden by helping individuals with some of the costs of their medication.

Dear Donor,

Your support is critical to the success of the fund. We can’t do it without your financial support. Every dollar you give will make an impact. All donations will be used to support and help individuals who are unable to pay the cost of medicine. Donations may be submitted via Pay Pal.

Donate Here

Dear Provider,

Whether you are pharmacy, provider, hospital or clinic, you are the first person where individuals realize they have challenges paying for their medication. Please help them by completing the online application.

Dear Individual,

Upon approval, NAMI Kern County will pay the cost you are responsible for.

NAMI KERN is an affiliate of NAMI California. We are a grassroots 501 (c) 3 nonprofit corporation made up of families, friends, professionals, students and individuals whose lives have been affected by serious mental illness.

Community Asistance Fund Referral Form

Eligibility Requirements: Must be diagnosed with a serious and chronic mental health condition. Must be referred by licensed physician, hospital or clinic Program 1: Individuals are unable to afford the medication they need.

Step 1 of 3

33%

Date:
Date Format: MM slash DD slash YYYY
Diagnosis:
Relationship to Client:*
- Physician
- Psychiatrist
Client's Name:
First Last
Date of Birth:
Client's Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Client's Cell Phone:

Referred by Name:
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone:

Cost of Medication:
Amount Owed:
Pharmacy Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pharmacy Telephone:

About NAMI Kern

Mailing Address:
National Alliance on Mental Illness
P.O. Box 9144
Bakersfield, CA 93389-9144

Helpline: (661) 858-3255
Email: namikern@yahoo.com
www.facebook.com/NAMIKernCounty

NAMI Kern County is an IRS recognized 501(c)(3) Non-Profit Organization and all donations are tax deductible as allowed by law.

Federal Tax ID #77-0289372

STATE & NATIONAL LINKS:

NAMI Kern is an affiliate of NAMI California. We are a grassroots (501(c)3 nonprofit corporation made up of families, friends, professionals, students and individuals living with mental illness.

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CALL THE NAMI HELPLINE

800-950-6264

IN A CRISIS? TEXT NAMI TO 741741

Please consider donating to
NAMI Kern County

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