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ACEing Autism Scholarship Application

Thank you for your interest in our program! Scholarships are available to anyone in need of financial support. They typically cover the cost of the entire registration fee and are valid for one year, to be used for multiple sessions within that year. After that year, you are welcome to re-apply. Once you submit your application, you will be contacted by our team by email.
1.Participant's First & Last Name:(Required.)
2.Participant's Date of Birth
*Participant must be 5 or older to participate (Required.)
3.Parent or Guardian's Name:(Required.)
4.Parent/Guardian Email:(Required.)
5.Address:(Required.)
6.Phone Number(Required.)
7.Which ACEing Autism program are you applying for?
Please make a maximum selection of 2 program locations. (Required.)
8.What is the total number of children living in your household?(Required.)
9.What is the total number of adults living in your household?(Required.)
10.What is your current yearly household income?(Required.)
11.Please provide details about why your family is in need of financial assistance.(Required.)
12.I certify that all of the information on this application is true and correct, and that all income is reported. I understand that this information is being given for the receipt of fee assistance. I agree to inform the Program Director if I no longer qualify to receive the program scholarship. I understand that the participant may become ineligible for fee assistance due to excessive absences. I will abide by the requirements of the scholarship agreement.(Required.)