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Request Funding 


Jillian's Jitterbug Foundation's goal is to supply as many families with the help they need.  We want to help your special needs child to become independent and mobile.  In order to request funding, print out the following form below and fill out the specified information.  If you are unable to print out an application, give us a call or send us an email and we would be more than happy to mail you a hard copy.  Once the form is completed, please mail it to the address listed below.  Upon receiving your request form, we will review it and be in contact with you.


Since we want to be able to provide as many families as possible with financial assistance, a maximum amount of $500 will be allotted to each family within a 24 month period.  The amount given per family will be determined based on a case by case approval by our board of directors.   



190 Kings Ridge Court

Southern Pines, NC 28387

Tel: (609)-949-4588


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