Apply for a Scholarship

Part of The Green Apple Project’s mission is to assist families with their unmet needs in caring for their family member who is on the autism spectrum. Scholarship are offered to assist autistic individuals with their mental health and educational needs. Examples include assistance with the costs of therapy, purchase of sensory kits and weighted blankets and vests, assistance with the costs of specialized childcare or adult care, purchase of educational aids such as tablets and sensory toys, assistance with the costs of tutors, and assistance with the costs of transportation to appointments with specialists outside the Lewis Clark Valley. If you are requesting assistance with more than one scholarship area, please complete an individual application for each. Scholarships are based upon funds available. Personal information will be kept in strict confidence.

Name of person completing this application

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Please provide the best phone number to reach you.

(###)

###

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Name of recipient of this scholarship

Relationship to recipient of this scholarship

Age of recipient of this scholarship

Please select which of our scholarship programs you wish to apply for.

Please provide specific details about your request (ie. items and type, travel to an appointment, support for therapy, etc.).

Why are you making this request?

What benefit will you receive from this scholarship?

Was this scholarship request recommended by a provider (ie. did a doctor, counselor, behavorial therapist recommend requesting a scholarship from Green Apple)? If not, please answer N/A

Estimated Cost of Scholarship

Please estimate how much you think your request will cost. If not available please leave blank

Link

Please provide a link to the active if you have it

Estimated Need Date For Request

If applicable

YYYY

Race

This information is required for reporting purposes.

Ethnicity

This information is required for reporting purposes.

Number of people in your household

This information is required for reporting purposes.

Total annual household income

This information is required for reporting purposes.

Are you connected in any way to a member of the Board of Directors for The Green Apple Project

i.e. relative, friend, etc.

If you answered yes to the above question, please describe the nature of your connection to a board member (i.e. relative, friend, etc.)

An answer is required if you answered “yes” above.

I certify that the information included in this scholarship application is true and correct to the best of my knowledge

Date

YYYY

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