Teen & Adult Independence Assistance Package Request Form

Please fill out the form below to request a Cure SMA Teen & Adult Independence Assistance Package. Upon submitting the request form below and confirming your eligibility for this program, we will ship out your package in the order it was received.

Please email supportpackage@curesma.org with any questions. Also, please note we are unable to ship to P.O. boxes.

**This is a separate supplemental package from the original Teen & Adult Support Package that was launched in 2018, so please apply below if you have not yet received the items listed below.

Independence Package Includes:

Logitech Blue Snowball Microphone

WiFi Smart Plugs

Travel UV Sanitizing Wand

Universal Cup Holder

Telescopic Metal Straws

Jar Opener with Base Pad

Multi Kitchen Tools Set

1. I acknowledge I have read through the eligibility criteria above and meet all of the requirements.

Eligibility Criteria:

Must have confirmed SMA diagnosis.
Must be 13 years of age or older
Must live within the U.S.

*This question is required.

Are you affected by SMA or are you filling out this request on behalf of a person with SMA? *This question is required.