Requests will be presented quarterly to the Gonzales Trust Committee for review. Approved requests will be forwarded to The Arc of the United States for final approval. Requestees will be notified of the Committee’s decision. If more information is necessary for review, you will be contacted by Alexandria Lofton, Trust Director, The Arc of New Mexico.


The following criteria apply to this request:


· Applicant must be a person with Down syndrome who legally resides in New Mexico or a family member or legal guardian applying for services/supports on behalf of a child or adult with Down syndrome.
· Applicant may be a family member of a person with Down syndrome to attend a conference, receive education or training that directly benefits the person with Down syndrome.
· Grants are limited to $5,000 annually per household—payments are not made directly to the individual or family. The Arc of New Mexico will pay the vendor, contractor, agency, or merchant directly for the approved service or program.
· Eligible purchases would be for items, devices, services, that are not available to the individual through other reimbursed or directly funded insurance, Medicaid state plan, DD waiver, etc., e.g. cellular phones, tablets, computers, unusual home modifications, communication devices, transportation services not available through other programs, vehicle modifications, new adaptive equipment not available through typical service programs, etc.

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* REQUESTER'S INFORMATION

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* What is your relationship to the individual with Down syndrome?

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* Business, organizing agency, or service provider to be paid:
**Please do NOT list yourself or another individual person**

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* TOTAL AMOUNT REQUESTED INCLUDING TAX AND DELIVERY $

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* Have you already received $5,000.00 this year from the Gonzales Trust in the individual support category?

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* How much have you received, in total, from the Gonzales Trust individual support category?

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* What are you requesting the funds for?

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* Does this directly benefit the individual with Down syndrome? Please explain how.

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* Is this a need that is not fulfilled by other funding programs? (Medicaid State Plan, DD Waiver, Vocational rehabilitation, etc.) Please explain.

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* Is there anything important about the request that you would like to share?

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* Budget breakdown or invoice: Until The Arc receives a quote, invoice, or budget breakdown, your application will be incomplete.

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