A. John Paul Memorial Respite Scholarship
PARKINSON SUPPORT GROUP OF THE FINGER LAKES
Website: ParkinsonSupportGroupOfTheFingerLakes.com
The Parkinson Support Group of the Finger Lakes is offering funds from the John Paul Memorial Respite
Scholarship Program. These funds are available to honor and memorialize the efforts, support and
friendship of our group’s founder, John Paul (1934-2020). We also gratefully thank Pat Smith for her continuing efforts in support of PSGFL and those with Parkinson’s Disease and Care Partners.
We are offering $100 “respite” scholarships (one per household) to you, our PSGFL members, so that you can find hope, joy, determination, peace and thankfulness for your continuing journey with Parkinson’s Disease.
You may wish to enjoy a day at the spa, a special dinner at a restaurant (or ordered in), a house/pet sitter so you can take a little trip, maybe indulge in some special champagne, or something else that will bring happiness. We want you to take time for yourselves, take a long-needed break and breathe a bit easier for your respite time. Use of funds is at your option; however, please let us know how you found joy and respite with your $100.
Although we are taking only new applications, if you were a past recipient of funds from this program, we were glad to make funds available for you and your loved one at that time.
Please print and complete the form below and mail it to: PSGFL, P.O. Box 131, Canandaigua, NY 14424. Submissions
will be reviewed by the PSGFL Steering Committee on an ongoing basis.
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FORM A:
To memorialize the contributions of our founder John Paul, I (we) wish to find joy and
comfort with the use of this scholarship.
(Please share your plan for use of these funds in the blank below.)
____________________________________________________________________________________
Your name (please print): _______________________________________________________________
Check below whether the person above is:
____ an Individual with Parkinson’s Disease,
or
____ a Care Partner for (name of individual with PD): ________________________________________
Address (street, city, state, zip code): ______________________________________________________
_____________________________________________________________________________________
Phone: (Home) ____________________________; (Cell)______________________________________
Email: _______________________________________________________________________________
Please return completed form for review to: PSGFL, P.O. Box 131, Canandaigua, NY
If you have questions, please email Trish Haggett: trish.haggett@gmail.com
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END OF FORM A
PARKINSON SUPPORT GROUP OF THE FINGER LAKES
Website: ParkinsonSupportGroupOfTheFingerLakes.com
The Parkinson Support Group of the Finger Lakes is offering funds from the John Paul Memorial Respite
Scholarship Program. These funds are available to honor and memorialize the efforts, support and
friendship of our group’s founder, John Paul (1934-2020). We also gratefully thank Pat Smith for her continuing efforts in support of PSGFL and those with Parkinson’s Disease and Care Partners.
We are offering $100 “respite” scholarships (one per household) to you, our PSGFL members, so that you can find hope, joy, determination, peace and thankfulness for your continuing journey with Parkinson’s Disease.
You may wish to enjoy a day at the spa, a special dinner at a restaurant (or ordered in), a house/pet sitter so you can take a little trip, maybe indulge in some special champagne, or something else that will bring happiness. We want you to take time for yourselves, take a long-needed break and breathe a bit easier for your respite time. Use of funds is at your option; however, please let us know how you found joy and respite with your $100.
Although we are taking only new applications, if you were a past recipient of funds from this program, we were glad to make funds available for you and your loved one at that time.
Please print and complete the form below and mail it to: PSGFL, P.O. Box 131, Canandaigua, NY 14424. Submissions
will be reviewed by the PSGFL Steering Committee on an ongoing basis.
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FORM A:
To memorialize the contributions of our founder John Paul, I (we) wish to find joy and
comfort with the use of this scholarship.
(Please share your plan for use of these funds in the blank below.)
____________________________________________________________________________________
Your name (please print): _______________________________________________________________
Check below whether the person above is:
____ an Individual with Parkinson’s Disease,
or
____ a Care Partner for (name of individual with PD): ________________________________________
Address (street, city, state, zip code): ______________________________________________________
_____________________________________________________________________________________
Phone: (Home) ____________________________; (Cell)______________________________________
Email: _______________________________________________________________________________
Please return completed form for review to: PSGFL, P.O. Box 131, Canandaigua, NY
If you have questions, please email Trish Haggett: trish.haggett@gmail.com
----------------------------------------------------------------------------------------------------------------------------------------------------------
END OF FORM A
B. General Scholarship
PARKINSON SUPPORT GROUP OF THE FINGER LAKES
Website: ParkinsonSupportGroupOfTheFingerLakes.com
The PSGFL Steering Committee is continuing to offer financial assistance to its members from its
fundraising efforts to defray costs of participation in programs or to assist in purchasing equipment and
other resources to those with Parkinson’s Disease and their Care Partners.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FORM B:
Financial assistance from General Scholarship requested for the following:
Please check one:
___ Membership fees for a YMCA or any other gym
___ Costs related to physical therapy programs. (Note: Prior to starting Rock Steady Boxing or other physical
therapy programs, pre-screening may be required to evaluate fitness to participate.)
___ Assistive devices: Examples wheelchairs, walkers, canes, walking poles, bed rails, hand-reaching tools, ergonomic utensils and scoop plates, transfer belts, shower chairs, commodes, grab bars, leg lifters, hand weights, bed ladder assists, button assist devices, etc.
NOTE: Please be specific on your request for any of these devices, including related costs:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___ Other items (not listed): Please be specific on your request, including related costs:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Your name (please print): _______________________________________________________________
Check below whether the person above is:
____ an Individual with Parkinson’s Disease,
or
____ a Care Partner for (name of individual with PD): __________________________________________________
Address (street, city, state, zip code): __________________________________________________________________________
________________________________________________________________________________________________________
Phone: (Home) ______________________________; (Cell)______________________________
Email: _________________________________________________________________________
Please return completed form for review to PSGFL, P.O. Box 131, Canandaigua, NY 14424
If you have questions, please email Trish Haggett: trish.haggett@gmail.com
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END OF FORM B
PARKINSON SUPPORT GROUP OF THE FINGER LAKES
Website: ParkinsonSupportGroupOfTheFingerLakes.com
The PSGFL Steering Committee is continuing to offer financial assistance to its members from its
fundraising efforts to defray costs of participation in programs or to assist in purchasing equipment and
other resources to those with Parkinson’s Disease and their Care Partners.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FORM B:
Financial assistance from General Scholarship requested for the following:
Please check one:
___ Membership fees for a YMCA or any other gym
___ Costs related to physical therapy programs. (Note: Prior to starting Rock Steady Boxing or other physical
therapy programs, pre-screening may be required to evaluate fitness to participate.)
___ Assistive devices: Examples wheelchairs, walkers, canes, walking poles, bed rails, hand-reaching tools, ergonomic utensils and scoop plates, transfer belts, shower chairs, commodes, grab bars, leg lifters, hand weights, bed ladder assists, button assist devices, etc.
NOTE: Please be specific on your request for any of these devices, including related costs:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___ Other items (not listed): Please be specific on your request, including related costs:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Your name (please print): _______________________________________________________________
Check below whether the person above is:
____ an Individual with Parkinson’s Disease,
or
____ a Care Partner for (name of individual with PD): __________________________________________________
Address (street, city, state, zip code): __________________________________________________________________________
________________________________________________________________________________________________________
Phone: (Home) ______________________________; (Cell)______________________________
Email: _________________________________________________________________________
Please return completed form for review to PSGFL, P.O. Box 131, Canandaigua, NY 14424
If you have questions, please email Trish Haggett: trish.haggett@gmail.com
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END OF FORM B