All information you provide will be used to help the Brain Injury Resource Center of Wisconsin build a better picture of brain injury in Wisconsin. Data will be stored securely and confidentially following data protection laws. Each card is personalized, helping the cardholder explain their brain injury’s effects and request any support they may need.
The following items are required before issuance of the Brain Injury Identification Card:
1) A passport-style photo of yourself, ready to upload to the form. Please ensure:
- Passport size and style photo
- The photo is in color
- The photo is clear and in focus
- The photo is without any creases or tears
- You are facing forward and looking straight at the camera
- Sunglasses are not worn (prescription glasses are permitted)
- You do not have a head covering (unless it’s for religious or medical reasons)
- No other persons may be shown in the photograph
- A plain background or an unidentifiable location in the background is required
- No animals may be in the picture
- Smiles are preferred, but not required
2) Print, complete, and return the Resource Facilitation-Survivor Form and the Acquired/Traumatic Brain Injury Verification Statement
Resource Facilitation-Survivor Online Form
Acquired/Traumatic Brain Injury Verification Statement
Please note: due to a recent increase in the number of brain injury wallet card applications received, processing your application and sending out your ID card may take up to 4 weeks.
FAQ: About the Brain Injury Wallet Card
Why should I carry a Brain Injury Resource Center of Wisconsin – Brain Injury Wallet Card?
As the seasons change and the weather causes a change to surfaces (snow, ice, wet leaves, mud, and so on) unsteady walking can occur. It is reassuring to know that in situations that may require contact with Emergency Responders the ID card can be shown. Emergency responders are trained to look for many forms of medical ID, and the Brain Injury Identification Wallet Card alerts them that the individual has a brain injury and the potential conditions it may have caused.
After a brain injury, people may have problems with social skills. These problems can differ from person to person and can be harder to manage when feeling strong emotions, such as anger or excitement. The Brain Injury Identification Wallet Card can be presented and used to help others understand.
- Feeling out of place and uncomfortable around other people
- Interrupting conversations
- Losing focus during a conversation
- Forgetting what someone has said
- Misunderstanding the words, facial expressions, tone of voice, or actions of others
- Difficulty getting along with others
- Talking too little or too much
- Having trouble expressing thoughts and feelings
- Not showing interest in what others have to say
- Not knowing how to start or maintain a conversation
- This is your first step towards educating the community on life after brain injury
Who can apply?
The card is available to anyone in Wisconsin aged 18 and over who has a verifiable brain injury. If you are living in another state that does not offer the Brain Injury Identification Wallet Card, Wisconsin criteria apply.
I’m not currently involved with BIRCofWI. Can I still apply for a card?
Yes. Anyone living with the effects of brain injury can apply for a card, however, a Resource Facilitation Specialist will contact you for basic information and a completed Brain Injury Verification Form is required.
I have never come into contact with the police – is this card for me?
Absolutely! The card can be used in many different everyday social scenarios to help you access any support you may need.
What is required?
Clinical verification of brain injury and a photo are required, as well as some information about how your brain injury affects you. A Resource Facilitation Specialist will contact you for basic information
How much does it cost?
The card is provided free of charge (donations to defer the cost of creating a card is appreciated)
How long does it take to get my card?
Once the Brain Injury Verification Form has been completed and received, it may take 4 to 6 weeks to receive the card.