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Autism Meets Faith Grant Application
This application is designed for parents seeking financial assistance from Autism Meets Faith to cover expenses related to their child's therapy services. It is important to note that submitting this application does not guarantee approval. Here are the grant cycles and key dates:
- Cycle 1:
- Application Window: January 1 - January 31
- Awards Announced: March 1
- Cycle 2:
- Application Window: April 1 - May 1
- Awards Announced: June 1
- Cycle 3:
- Application Window: July 1 - August 1
- Awards Announced: September 1
- Cycle 4:
- Application Window: October 1 - November 1
- Awards Announced: December 1
Please be aware that grants are provided once per year to each family. Autism Meets Faith will make direct payments (up to $200) to the child's therapy center on behalf of the recipient; however, no funds will be disbursed directly to the household. It is a requirement for all recipients to provide documented proof of their child's autism spectrum diagnosis from a qualified medical professional to qualify for the grant. Additionally, Autism Meets Faith reserves the right to utilize the information collected for fundraising campaigns. Applications may be submitted at any time, but approval is subject to the outlined criteria and availability during the specified grant cycles.
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* Indicates required question
Email
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Your email
Parent/Guardian Name
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Your answer
Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Phone#
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Your answer
Child Name
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Your answer
Additional Child Name
Your answer
Additional Child Name
Your answer
Child Date of Birth
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MM
/
DD
/
YYYY
Additional Child Date of Birth
MM
/
DD
/
YYYY
Additional Child Date of Birth
MM
/
DD
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YYYY
Child Diagnosis
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Your answer
Additional Child Diagnosis
Your answer
Additional Child Diagnosis
Your answer
Can you provide a diagnosis form confirming an ASD diagnosis from your child's doctor or school?
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yes
no
Is this request for current therapy services received by your child or new services?
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current
new
What type of therapy are you requesting a grant for?
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Your answer
Therapy Center Contact Information
Please list the name, phone number, address, and contact person for the center where your child receives services that the grant will be paid upon approval.
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Your answer
How will this grant benefit your child and family?
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Your answer
Amount requested
The final amount will be determined if approved by the current deductible and co-pays. It may be less than the amount requested.
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Your answer
Household Income
Include the income for all adults living in the house (salary, self-employment, government assistance, child support, spousal support, etc.)
Yearly income does not guarantee approval or denial.
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$0-$20,000
$21,000-$30,000
$31,000-$40,000
$41,000-$50,000
$51,000-$60,000
$61,000-$70,000
$71,000-$80,000
$81,000-$90,000
$90,000-$100,000
$100,000+
Do you receive other financial aid to cover the cost of therapy or government assistance (SNAP, TANF, Medicaid, Social Security, etc.)?
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Yes
No
Please list all financial assistance received below (If you do not receive any assistance, type N/A).
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Your answer
Autism Meets Faith can support families like yours based on charitable donations. Awareness is a crucial factor in receiving donations. If approved, can you leave a Google review for Autism Meets Faith?
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Yes
No
Does your child need additional support (food, clothes, sensory items)? Please indicate additional support needed in the space below.
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Your answer
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