2020 - 2021 Mini Grant Application
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Name *
Are you over 18 years old? *
Do you have a social security number? *
Address *
City *
State *
Zip Code *
Phone Number *
Email *
Child's Name *
Child's Age *
Does your child have vision and hearing challenges? *
What is your child's disability? *
How much money are you requesting? (up to $500.00) *
How will you use the grant funds to support your child or family? *
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