Grant must be submitted by: May 15 , 2014

Grants awarded by: June 15, 2014

Purpose

The purpose of the (ASMC) Autism Society of McLean County’s iPad Grant is to promote the use of technology to improve an individual’s quality of life and independence. ASMC is dedicated to making a difference in the lives of our members and families we serve.

Eligibility

Current Members of the Autism Society of McLean County includingIndividuals, parents, and caretakers, who reside within the United States are eligible to apply for this grant.

Professional Letter

A letter of recommendation from a professional (teacher, therapist, etc.) must accompany the request. The letter should include the child/individual diagnosis and how an iPad would be of benefit.

Terms for Acceptance

The application must be fully completed. The Autism Society of McLean County will have sole discretion to accept or reject any application based upon information provided through the application. All decisions to decline a grant are final and may not be appealed.

Nondiscrimination Policy

Applicant confirms it is in compliance with the ASMC’s nondiscrimination policy. ASMC seeks to promote respect for all people. ASMC will consider applications from individuals whodo not discriminate on the basis of race, color, religion, gender, national origin, ancestry, age, medical condition, disability, veteran status or any other characteristic protected by law.

ASMCiPad Grant

One iPad will be awarded in this grant cycle. The Board of Directors will determine if we will have another grant cycle based on the organizations financial ability. All applications will be reviewed by the ASMC iPad Grant Committee and determined based on meeting eligibility and need. All decisions are final and at the sole discretion of the committee.

Each application will be kept in our system for one year after which the applicant must re-apply to be considered. The committee may use its discretion to limit iPad awards per household for the life of the grant.

We will review the following items when considering approval of a grant request:

  • Completion of grant application – The application must be completed in its entirety to

be considered.

  • Household income – While we have not set an income level cap, incomes below $60,000 per year are reviewed first.
  • Numbers of family members with ASD diagnosis – Applications from families with multiple children with ASDs are reviewed first.
  • Need and purpose of use.

ASMC iPad Grant Recipient Release

By completing the grant application form, I understand that ASMC may publish my name and or request a picture for publication to share on our website, in brochures, or other media to promote the iPad Grant and the Autism Society of McLean County.

ASMC iPad Grant Awards

Chosen recipients will be contacted by letter, email or phone within 3 weeks of the end of the grant cycle.

First Name Last Name

EmailPhone

Mailing Address

CityStateZip

Your relationship to the child:

Individual with ASD MotherFather Guardian

Marital Status: Married Single Divorced

I have an autism spectrum disorder - or complete the next question Yes ____ No ____

I have a child or children with and autism spectrum disorder - How many? ______

Age ____ Age____Age ____

Household Income: ______

Why are you applying for the ASMCiPad Grant? How will this help you or your child(ren)?

(Attach extra page if needed)

Other information that may help us in our decision making:

If I am selected as a recipient I agree to share my name and photo for the promotion of ASMC and/or the iPad Grant. Yes No

Letter of Recommendation (may be emailed to or mailed to the address below)

How did you hear about the ASMC iPad Grant?

ASMC Website Facebook Friend Internet Search Teacher

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