Apply

Please complete the following fields to request an application. Thank you for your interest in the Kees Brenninkmeyer Foundation.

    Name

    Email

    Phone Number

    Mailing Address










    Street Address











    Injury Description

    Have you seen a physician regarding this injury?

    Career Type

    Career Description

    Medical Insurance

    Do you have or anticipate future access to crowd funding or other fundraising platforms?

    How were you informed about the foundation?

    Please verify the following image

    captcha

    Featured Testimonial

    "After a long fall and a painful broken ankle I flew home to Colorado to begin the challenging and stressful process of scheduling a surgery. I learned quickly that my health insurance was frustratingly inadequate for the procedure that I required; an all too common story. After learning that I would receive assistance from the Kees Brenninkmeyer for the operation, my outlook on the situation wholly improved and contributed greatly to my mental recovery as well as proper healing of my fibula. Because of the foundation paying for not only my surgery, but the necessary physical therapy, I am able to continue the course I have laid out for myself and finish the guide track program. My accident was nearly five months ago and I am now guiding again and preparing for an upcoming exam. I am so grateful for the assistance that I received and hope that others in my situation can find their way to this wonderful foundation. "

    - Steven Van Sickle

    Read More