Please Review Guidelines below prior to
completing this form to submit a request
Request Requirements: MUST be adhered to for request to be considered.
Children are eligible for individual grants on an every other year basis.
Maximum Individual Grant is $1200.00.
Maximum Program Grant is $3000.00 per year; Requests may be submitted annually.
To request Program participation, individuals should contact the program directly.
If a child receives an individual grant, he/she is not eligible for program participation in that same year.
• "Diagnosis" section MUST include one or more criteria exactly as outlined here.
Additional diagnoses (ex. Autism, CP, etc.) are helpful but alone do NOT qualify.
"Description of Request" section MUST include single, specific item/need which is Recreational and/or Educational in nature. (May include equipment, certain home modifications, adaptive items, etc.; Areas of need such as safety, behavior, utility bills, etc. are not funded)
"Specific Amount Requested" section MUST be specific to request (may include s/h charges; cannot be open-ended or undetermined).
In addition to Form submission, the following documentation MUST be faxed to 856-435-1475:
1. Therapist letter confirming criteria of moderate-severe delay with age level(s) of current skill/function included.
2. Specific item information from vendor (ex. Copies of catalog page with item/description circled + order form (including shipping/handling costs; quote on vendor letterhead, etc.)
Please complete the initial application below.
If above requirements are met, you will be contacted within approximately 4 weeks.