To Request Funding:

Please clearly state the use of the funding in the comment box below. Our primary goal is to get individuals with Autism Spectrum Disorder to the outdoors BUT we will consider awarding funding to Autism programs across the state that may not necessarily fit that mold.

Name:

First Name

Last Name

Email Address:

Contact Number:

(please include area code)

Amount Requesting:

What do you need the funding for? How does it involve kids on the spectrum?

Address for the CHECK:

Please include a current address for the check to be mailed to if chosen.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tax ID Number

Of the organization that is requesting donation.

Name for the CHECK:

Please write in the name for the check to be made out to if chosen.