Baio Institute Scholarship Application

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Baio Institute is a Non-profit organziation providing support to autistic individuals and their families. Please complete the following required information to determine if you qualify for a scholarship.

Additional information such as some tax information may be requested seperately depending on the financial request.

Email *

First & Last Name *

Phone Number: *

Child's First & Last Name if applicable

Are you or is your child autistic? *

Myself

My child

Other:

Please describe in detail your scholarship request. (ex. name specific training, therapy, or item requesting *

What is your annual household income? *

How many dependents (individuals that rely on your income)? *

If requested, will you be able to provide your tax/income information *

Yes

If requested, will you be able to provide proof of diagnosis from a doctor *

Yes

Send me a copy of my responses.

Submit

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