Application for Agencies or Groups

Grant Application for Agencies, Groups or Special Projects

Grants are reviewed on a monthly basis.
Proof of Autism diagnosis for at least 2 group members should be submitted with your application (Doctor’s note, OPWDD Statement, IEP Cover Page, etc.). Please remove any identifying information for each individual.
Applications without sufficient information will not be considered until the packet is complete.
Checks will be made out to the provider and sent to you.

"*" indicates required fields

My grant request falls within the following area.*

Recreational/Arts

Educational

Social

Project

Sponsorship

Therapeutic

Please describe a brief description on how the funds will be used.

Name of group/organization who will be receiving the grant.*

This is who your check will be made out to unless otherwise specified below.

Person completing this application*

Please include name, title, address, phone number and email. This is where the check will be sent.

Amount requested*

(Please be aware partial payment may be granted.)

There may be some circumstances where you have already paid for materials or a service and are looking for reimbursement. If that is the case, please explain, submit your receipt and your grant will be considered. Receipts must be dated within the last 6 months.

Upload required documentation of Autism diagnosis or your group's mission statement.

Max. file size: 50 MB.

Upload required documentation for invoices/receipts or donation amount requested.

Drop files here or

Max. file size: 50 MB.

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