DSAW - Apply

Down Syndrome Association of Wisconsin Member Grant Application

The DSAW Member Grant program is available to anyone whose membership in the organization is current and active.

Due to new processing guidelines, applications may now be approved within one business week by DSAW's Executive Director.

Name:

Address:

City:

State:

Zip code:

Daytime phone:

Email address:

Full name of child/person with special needs:

Age of child/person with special needs:

Your relationship to the child/person with special needs:

Activity you are planning to attend or requested service or item:

If conference or class please fill in activity date:

If conference or class please fill in activity location:

How will this request benefit the child/person with special needs?

Have you used the DSAW Member Grant program before?

Have you requested support from any other source?

Total cost for the conference, program, course, service or item:

Amount you are requesting from the DSAW Member Grant program:

Enter the code shown: