Professional Development Grant

You may submit more than one request per year however, priority will be given to those who have not yet received personal development grant funds within the current calendar year.

 Grants are intended for the use of individuals, families and providers to assist the individual and/or his/her family to participate in events and activities that foster integration and community Inclusion.  A certified independent provider may also request grant dollars for specific training relating to an individual served within Auglaize County.

 This reimbursement request form must be received 30 days prior to the event.  Reimbursement is not guaranteed. Email completed reimbursement request along with event information or a link to the event to Leslie West lwest@auglaizedd.org or mail to:  Auglaize DD, Attn: Leslie, 20 East First St., New Bremen, OH 45869.  Questions?  Call (419) 629-1502 Ext. 101 (8 a.m. – 4 p.m. weekdays) 

 You will be contacted by no later than fourteen (14) days after we receive the application with the approval status.  You will then need to submit a copy of your receipt of payment and/or registration confirmation to lwest@auglaizedd.org.  Reimbursement will be processed within thirty (30) days of receiving a copy of your receipt of payment and/or a copy of your registration confirmation.

 

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Name: *
Please identify which one is relative to you. *
Address: *
Phone Number(s) *
Email: *
Name of Event: *
Date of Event: *
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DD
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Have you received funds from the Auglaize DD Professional Development Grant in the past 12 months? *
Please select one of the following: *
Refer to previous question. If you answer 'supplies' or 'other', please explain.
How is this relevant to the individual as it pertains to the goals in their ISP? (If seeking reimbursement for training cost, please disregard). 
Cost Reimbursement Requested For: *
Required
Price for Hotel: $
If you are not requesting reimbursement for a hotel, please leave blank. 
Price for Event Registration: $
If you are not requesting reimbursement for event registration, please leave blank. 
Price for Supplies: $
If you are not requesting reimbursement for supplies, please leave blank. 
Price for Other: $
If there is something else not listed above that is requested for cost reimbursement, please list item and price below.
Certification Statement: By signing my name below, I confirm that all of the information provided above and in the accompanying documents (if any) if true and correct to the best of my knowledge. I also understand that if approved, I must pay all registration fees and provide supporting documentation of such payment prior to receiving payments of said reimbursement. (Name & Date below). *
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