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Different Needz Foundation Individual Grant Application 2019
Different Needz Foundation
Individual Grant Application Directions

The Different Needz Foundation is a 501(c)(3) charitable organization with a mission to provide grants to individuals with developmental disabilities and the families and organizations that support them with the necessary medical services and/or equipment needed to ensure the best quality of life.

Note to all Applicants: Grants are awarded at the sole discretion of the Different Needz Foundation Board of Directors. If your grant request is approved, the equipment provider or service provider will be paid directly by the Different Needz Foundation.

Please read the following directions to help ensure that your application is completed properly and all requirements are fully met:

1. All application sections must be FULLY completed. Any uncompleted applications will not be considered for a grant.

2. Applicants or applications that do not qualify for a grant will not be considered. Recipient must have developmental disabilities as defined by the Foundation.

3. "Applicant" is the person filing out the form. "Recipient" is the person that will receive the item or service. If an applicant is completing the grant request for a non-family member (i.e. case worker, patient navigator), please indicate your relation to the recipient and provide the contact information for the recipient’s parent/guardian (name, address, phone and email) on the application.

4. It is mandatory to include with your application; price quotes*, catalog pages, service provider details or other information that specifically describes what you are requesting and supports the amount you are seeking, including any associated shipping/freight costs. Failure to fully provide this information will disqualify your application.

*NOTE: We will not fulfill grant items from Amazon.

5. The Foundation will not accept applications requesting motor vehicles or adaptations to, Apple iPads or other comparable electronic tablet/device, service dogs or service dog training, or emotional support animals.

6. Do not include personal photos or any other documents that are not requested, for example: tax returns.

Notification of the Foundation's determination will be sent to applicants via regular U.S. mail in the month of May 2019. The Foundation may contact you for further information.


Thank you.

Applicant's Name: *
Recipient's Name: *
Recipient's Age: *
Recipient's Relationship To Applicant: *
Applicant's Street Address: (where the grant item(s) will be shipped) *
Applicant's City: *
Applicant's State: *
Applicant's Zip: *
Applicant's Phone Number: *
Alternative Phone Number: *
Applicant's Email Address: *
Item(s) Requested: The Foundation will NOT accept applications requesting Apple iPads or other comparable electronic tablet/device, service dogs or service dog training, emotional support animals or motor vehicles or adaptations to a motor vehicle. *
Cost of Item(s) Requested: (please be sure to include accessory items that may be required for use with this item) *
Website Link(s) to Item(s) or Service Provider (if applicable): NOTE: We will not fulfill grant items from Amazon. *
Please upload any supporting documents (must be clear and legible):
Have you applied for a DifferentNeedz grant in previous years?: *
If yes, were you awarded a grant?
If you were awarded a grant in the past, what year did you receive it and what was received:
Please tell us about the individual(s) that will benefit from the grant and their developmental disability: *
Please tell us about the service or item that you need and how it will benefit the individual(s). Include an explanation of the individual's experience with this item or service. Please include a detailed description of the service or item, the provider’s name, address and telephone number. *
What is the full amount of the grant being requested? *
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