Please complete the application below to apply for grant funding. These grant funds will be made available to support families of children with an ASD and individuals who have an autism spectrum disorder. Appropriate requests could include the following: funding to attend conferences/workshops related to ASD; travel expenses to attend NAzASA meetings; therapy services, materials, and/or expenses to attend therapy sessions; special projects that would benefit individuals with ASD. Please note that the maximum you can apply for is $2000.
Section 1: Grant Funding Period Desired:
Section 2: Your Contact Info:
Name:
Address:
City: State: Zip:
Phone Number :
Email Address:
Section 3: Nazasa / ASA Info Are you currently an Autism Society of America Member:
ASA Membership Number (if a member):
Have you attended any of the meetings of the Northern Arizona chapter?
If you have attended meetings, approximately, how many over the past 12 months?
Have you previously applied for the NAzASA Grant?
Date You Previously Applied for the Nazasa Grant (if applicable):
Section 4: Grant Project Info
Dollar amount of grant requested for this year: $
Please briefly and clearly describe your request (state how you will use the funds and include a brief budget):
Please describe how funding your request will benefit you and/or others (be specific):
Please provide a brief description of who you are and your connection to autism:
