The Cherie Levien Quality of Life Fund was created to provide respite for caregivers of persons living with prime of life neurodegenerative diseases including PSP, CBD, or MSA while knowing that professional services are in place for their loved one. Research indicates that even temporary or intermittent relief of caregiving demands can help reduce stress and improve the quality of day-to-day life for caregivers as well as for the person who is suffering with the disease.

The fund provides $1,500 grants for in-home care services by either our contracted provider Griswold Home Care, or a home care agency chosen by the awardee. You will not need to pay directly; Griswold or the agreed upon provider will be paid directly by CurePSP.

For any inquiries about the application or the fund, please contact Joanna Teters at teters@curepsp.org
Patient Information

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* 1. Contact information for patient

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* 2. Patient date of birth (MM/DD/YYY)

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* 3. Gender of patient

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* 4. Race/ethnicity of patient

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* 5. Is the patient of Hispanic or Latino origin?

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* 6. Marital status of patient

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* 7. Is the patient currently receiving care from a primary family carepartner?

Primary Family Carepartner Information

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* 8. Primary family carepartner's contact information:

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* 9. Primary family carepartner date of birth (MM/DD/YYY)

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* 10. Gender of primary family carepartner

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* 11. Relationship to patient:

Please complete the questions below if the person completing this application is different from the primary family carepartner listed above:

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* 12. Applicant contact information:

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* 13. Relationship of applicant to patient

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* 14. Gender of applicant

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