CFUCDF Life Enrichment Program Application

There are 4 things to have complete before we can review your application.

1. Be sure to fill out all fields on this form

2. Be sure to download the Physician Verification Form (PDF at the bottom)

3. Have a member of your metabolic team sign/date the form

4. Attach the Physician Diagnosis Form along with the invoice or registration of your chosen session, class, activity, or college course and email everything to OR you can snail mail the Physician Form and the Invoice/registration (online application is submitted electronically) to CFUCDF: 39252 Winchester Rd. #107-135 Murrieta, CA 92563. Email is the fastest way to begin processing your application. Invoices and registrations must be clear what the funds will pay for.



This program has been made possible by a generous grant from Horizon Pharma

Physician Verification Form located below as PDF

If this is an Equipment Award, please tell us how this will be a benefit
Rules are on the CFUCDF Life Enrichment Program main page
If applying for Equipment Award, tell us what you need:
If this does not apply simply mark NA
If this does not apply simply mark NA
If applying for an Equipment Award, please give us a description along with a pic and/or link (supply as much info as possible)

CFUCDF requires Proof of Registration/Invoice along with Physician's Diagnosis Form before disbursement of funds. Please check the box to acknowledge.

UCD Life Enrichment Program.Physician Diagnosis Form.English