Grant Application

The Michael Matters Foundation’s Requirements:

• The applicant must be a permanent Illinois resident.
• The applicant must submit a copy of their pathology report verifying diagnosis.
• Applicant household income can be no more than 400 percent of the Federal government’s poverty level. The most current Federal Poverty Guidelines will be used to determine income level per size of household. Generally, if your household income is below $100,000, you should qualify. For those with dependent children in the home, the threshold is higher. Poverty Guidelines can be found at https://aspe.hhs.gov/topics/poverty-economic- mobility/poverty-guidelines
• The Michael Matters Foundation’s Grant is a one-time grant eligible to patients with primary malignant brain tumors. The maximum grant award will be $2,000.00 per applicant with a maximum of one Applicant per family.

To Protect Its Interests, The Michael Matters Foundation May Also Request:

• Copy of Applicant household federal tax return for the most recent year.
• Applicant household bank statements from the last three months including checking, savings, CDs, and money markets.
• Copy of Applicant driver’s license or State ID.

Terms

For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby agree as follows:

I hereby authorize the release of information necessary for this application to The Michael Matters Foundation (“MMF”), so that MMF can process my request for assistance. I certify the information I have stated here is true and correct and that I am eligible for this Grant based on MMF’s requirements stated above. I also understand that MMF may verify the information on this application and that deliberate misrepresentation of information may subject me to denial of assistance and/or services. I give permission to MMF to discuss this application with any others deemed necessary to verify my information and/or identify additional sources of assistance. I understand that all information will remain as private as possible within these entities.

MMF reserves the right to determine if I meet the criteria based on an internal review of the application and other supportive materials, and is not required to provide a reason for denied applications.

In addition to the above Grant requirements, in the event I am chosen for this Grant, I may be requested to submit to a photo opportunity. Should that request occur, I hereby irrevocably grant MMF and its licensees, assigns, successors and other parties acting with its permission the perpetual rights throughout the world to:

1. make a formal check presentation to me;
2. use my name (first name, first initial of last name), image, likeness and personal brain cancer story (including without limitation how this Grant will be used) in MMF’s informational and promotional materials in any media.

Nothing in this agreement shall obligate MMF or any third party to make any use of the rights granted by me under these Terms. I hereby waive any right to inspect or approve any party’s use or exploitation of the rights granted under this agreement.

I hereby release and discharge MMF and its licensees, assigns, successors and other parties acting with its permission from any and all claims and demands arising out of or in connection with the exploitation of the rights granted under these Terms, including, without limitation, any and all claims for compensation, claims of defamation or any claims regarding rights of privacy or publicity.

To protect my identity, I understand MMF will only use my first name and the first initial of my last name in promotional materials. MMF will not use my full last name on any promotional materials. I also agree to allow MMF to include my contact information (provided on this application) in their private foundation database, which is primarily used to mail important foundation and brain cancer information to donors and friends of MMF.

I hereby warrant that I am at least age eighteen (18), or a dependent, have the legal capacity to enter into this agreement, and am not restricted from entering into this agreement. I state further that I have read these Terms in their entirety prior to affixing my signature below, and that I am fully familiar with the contents of these Terms and that I will comply fully with them. These Terms shall be binding upon me and my heirs, legal representatives, and assigns. The invalidity or unenforceability of any provision of these Terms shall not affect the validity or enforceability of any other provision of these Terms.