Autism Society of Mahoning Valley's
2019 Holiday Mini Grant Application

Deadline for entries is midnight on November 22, 2019.
Grant winner(s) will be decided by the Mike Hull Memorial Fund shortly after and
grants awarded at a holiday party in early December 2019. Families must
be located in Mahoning, Trumbull or Columbiana counties, since these
are the counties the Autism Society of Mahoning Valley serves. Child or adult must have an autism diagnosis. No monetary donations will be given.
For questions please email autismmv@gmail.com or call 330-333-9609.


* Required Field

*Person with Autism Name:


*Person with Autism Age:
*Person with Autism School/Program:
*Parent filling out application:
*Address:
*City:
*State:
*Postal Code:
*Phone Number:
*Email Address:
*Diagnosis:
*Physician who diagnosed:


Autism Society Events Participated in


PROJECT INFORMATION:
Tell us about your funding request. Please be specific about the requested item/service and how this item meets the needs and goals of your child with autism, and the estimated expense. Include any additional information that may be helpful in our decision.
*Summary of Project or Program (Please limit to one half page):


GRANT ACCEPTANCE COMMITTMENT:
I have read and understand that, if selected:
I will take photos with the Mike Hull Memorial Fund group and the Autism Society of Mahoning Valley;
and that this photo will be featured in the press release announcing grant winners; and in other social media.





Mahoning Valley Office
330-333-9609
autismmv@gmail.com
http://autismmv.org