CSDSA 2024 Scholarship Form
Complete the following information. Do not print out this form-it is for online submission only. Email receipts to scholarship@csdsa.org. CSDSA will no longer be mailing checks, reimbursement will be through PayPal.

FUNDING FOR OUR MEDICAL REQUESTS HAVE BEEN ALLOCATED FOR THE YEAR. WE ARE NO LONGER ABLE TO ACCEPT MEDICAL REQUESTS.
Sign in to Google to save your progress. Learn more
Email *
Date of Application *
MM
/
DD
/
YYYY
Applicant's Name *
Applicant's Age *
Name of Parent/Legal Guardian *
Phone Number *
Is your CSDSA membership current? *
Category of funding requested (select one) *
Specific items or services requested *
Estimated cost/amount of items/services requested *
(REMINDER: THE CSDSA DOES NOT PAY APPLICANTS DIRECTLY. IF THE SCHOLARSHIP APPLICATION IS APPROVED, THE CSDSA WILL EITHER REIMBURSE** THE APPLICANT OR FORWARD APPROVED FUNDS TO THE PROVIDER.) **Please email receipt to scholarship@csdsa.org if this is a reimbursement request.
Briefly explain how your request will benefit your family member with Down syndrome. *
Date by which funds are needed *
MM
/
DD
/
YYYY
Have you applied for CSDSA scholarship funding since January 1st of this year? *
What is the anticipated out-of-pocket expense for this request? *
PayPal Account information for reimbursement. We will no longer be mailing checks. Reimbursement will be through PayPal only.  *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms