Autism Social & Mental Health Grossmont Healthcare District Sponsorship
Thank you for your interest in attending the Autism Social & Mental Health conference on Friday, March 1st. Autism Society San Diego has secured a sponsorship from The Grossmont Healthcare District to provide full scholarships to attend for those living and/or working in their district. To find out if you qualify, click HERE for a map of the Grossmont Healthcare District. Learn more about Grossmont Healthcare HERE

To apply for these funds, please complete the application below.
Sign in to Google to save your progress. Learn more
Email *
Attendee Name: *
Attendee Address: *
Attendee City/Town: *
Attendee State: *
Attendee Zip Code: *
Attendee Email Address: *
Attendee Phone Number:  *
Do you live and/or work in the Grossmont Healthcare District?  This scholarship is only provided for those who live or work in this area. *
Are you a member of Autism Society San Diego?
Membership starts at $40 per year or $10 per month and provides you with a monthly newsletter and informational emails, early registration for some events, eligibility for our camps, free attendance at our pool parties, and the opportunity to apply for scholarships.  
 *
Are you a person with autism?
Priority for this scholarship is given to autistic individuals.
 *
Are you or your family member a San Diego Regional Center client? *
If you selected Yes above, have you already applied for funding with your service coordinator? 
Autism Society San Diego is vendored for this conference and the vendor number is PY3056. Clients of the San Diego Regional Center must apply for this funding before attempting to apply for this scholarship.
 *
Please advise why you are requesting these funds and how this conference will benefit you and/or your family. *
Thank you for applying. Your application will be reviewed by our scholarship committee and you will be notified if you are approved within one week.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Autism Society San Diego. Report Abuse
Google Forms