Colorado Discover Ability 2018-2019 Financial Assistance
Thank you for participating in CDA programs! This process will be completed on an annual basis beginning October 1, 2018 and will be good until September 30, 2019.
Colorado Discover Ability (CDA) is a non-profit organization and has limits on funding available for financial assistance. We strongly encourage participants to pay as much as they are able so that assistance will be available to others throughout the year. Our financial assistance is now provided on a sliding scale based on income. Because we have received some grant money allocated specifically for this purpose, our funders have requested that we collect the following information from you. All of the information requested is for CDA use only and will remain confidential, unless required to be reported as part of the grant.
* Required
Welcome to:
Which Program (s) do need financial assistance for? (Please check all that apply)
Youth Day Camp - ages 8 to 21
Camp Freedom - ages 6 to 12
Adult Days - ages 21 & up
Participant's First Name
*
Your answer
Participant's Last Name
*
Your answer
Veteran
*
Not a Veteran
Pre 2001
Post 2001
Prefer not to answer
Veteran
Not a Veteran
Pre 2001
Post 2001
Prefer not to answer
Veteran
Participant's Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Choose
Female
Male
Address
*
Your answer
City
*
Choose
Cedaredge
Clifton
Collbran
Battlement Mesa
De Beque
Delta
Fruita
Grand Junction
Mesa
Montrose
Olathe
Parachute
Rifle
Silt
Whitewater
State
*
Choose
AK
CA
CO
CT
FL
ID
ME
PA
UT
WY
Other
Zip
*
Your answer
Phone Number (include area code, no dashes please)
*
Please provide the best contact number.
Your answer
Email Address
*
Your answer
Participant's Ethnicity
*
Choose
American Indian
Alaskan Native
Asian
African American
Hispanic/Latino
White
Two or More Races
Other
Parent or Guardian completing application
*
Your answer
Relationship to Participant
*
Choose
Self
Parent
Child
Spouse
Friend
Host Home
Caregiver
Grand Parent
Aunt
Uncle
Other
Phone Number (include area code, no dashes please)
*
Your answer
Are you new to CDA?
*
Choose
Yes
No
Are you applying on behalf of a minor child or as the guardian of the client?
*
Choose
Yes
No
How did you hear about CDA?
*
Choose
Agency
Facebook
Friend
Grand Junction VA
I was referred
New Building
Powderhorn
Website
Other
What was your first year with CDA?
*
Choose
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
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