ADS Online Universal Grant Form

Our goal is to provide grants to those who might not have the means to access assistance to address their special needs

Mail in Grant Form

*Checks will be made out to provider and sent to you

*Upload proof of diagnosis (Doctor's note, OPWDD Statement, IEP cover page)

*Upload invoice for service

*Applications without sufficient information will not be considered until the packet is complete

Applicant's Name:
Applicant's Address:
Applicant's Phone Number:
Applicant's Email:
Program, service, or materials
for which you are applying:
Amount requested: $
Has applicant's insurance been billed: Yes
Check made payable to:
Proof of Diagnosis:
Invoice for service of materials: