DSAV Family Medical Grants - Fall 2022
DSAV will reimburse up to $250/DSAV member/provider for unpaid medical bills not covered by insurance  including but not limited to physical, occupational and speech therapies, assistive therapy devices, surgeries, dental, vision, orthodics, behavioral/mental health services and prescription drug costs not covered by insurance.  An Invoice from provider of service must be submitted before  request will be reviewed.

Submission of Billing statement(s) dated between October 1, 2022 and December 31, 2022 is required.  Email statement (s) to office@dsav.org
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Email *
Parent/Guardian Name (First and Last Name) *
DSAV Member Name (individual with Down syndrome) *
DSAV Member Date of Birth *
Street Address *
City *
State *
Zip Code *
Name of Provider (s)  - Checks will be made payable to the provider(s) of service(s) only, except for Prescription drug reimbursement. *
Amount Requested (max $250/Provider of Service) *
Families are asked to contribute 5 hours of volunteer time to qualify for funding.  Please select how your family will or did contribute in 2022 (select all that apply) *
Required
Comments
Please email a copy of billing statement to office@dsav.org or mail a copy to DSAV, 945 Boardman-Canfield Rd., Ste. 12, Boardman, OH  44512.  
A copy of your responses will be emailed to the address you provided.
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