Hunter Hinze Grant Application
Grant application for adults with autism to support transitions in adulthood.
Providers cannot apply for clients receiving services. While there are many qualified applicants, we are unable to fund every request. We encourage you to reapply in the next cycle if your request was denied.
Taking applications from May 1, 2019 to May 31, 2019 11:59 p.m.
Primary Contact *
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Name of Applicant with ASD *
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Applicant's Date of Birth *
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Address *
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County *
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Phone *
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Email *
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Tell us about the applicant's need: *
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Priority Area *
If awarded the grant, what are your plans for the funds? *
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In 3-4 sentences, tell us how this grant request will have a long-term impact on the recipient? *
Your answer
Total Amount Requested (not to exceed $500): *
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Provider Information
Please provide information about the provider/payee for requested funds. The provider cannot be the one requesting funds.
Name of Business Providing Service (Ex. Jane Smith Consulting Services): *
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Primary Contact for Business: *
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Preferred Form of Payment: *
Address of Provider/Payee: *
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Phone for Provider/Payee: *
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Email for Provider/Payee: *
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Additional Comments:
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