Community Assistance Fund

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 at-risk individuals living in low income, underserved communities with medication support and/or basic necessities.

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 at-risk individuals living in low income, underserved communities with medication support and/or basic necessities.

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 Assistance 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

Date:
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:

Community Food Pantry
- Yes
- No
Sponsored by Health Net
Cost of Medication:
Amount Owed:
Pharmacy Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pharmacy Telephone:

Community Assistance Fund

To Donors:

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 at-risk individuals living in low income, underserved communities with medication support and/or basic necessities.

Donations may be submitted via Pay Pal.

To Providers:

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.

Community Assistance Fund Referral Form

Step 1 of 3

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