To request financial assistance from the Tri-State Multiple Sclerosis Association, simply complete one of the applications listed below in the format you can use. We can only provide financial assistance to individuals diagnosed with multiple sclerosis that live in the tri-state area.  To see if you qualify please contact us prior to filling out the financial assistance forms.

Application cover letter in Adobe Acrobat
Application form in Adobe Acrobat

Download Acrobat Reader if needed 

Application cover letter in Microsoft Word
Application form in Microsoft Word

After completing any of the above applications, fax  to 812-423-5650 or e-mail to Director@Tristate.ms or mail to:

971 C. Kenmore Drive
Evansville, IN, 47714

Instructions on how to Attach a Document to an E-mail.