ABA Fund Application
With the generous donation from AHFF, we are excited to let you know we have funds to help families with community outings, program materials, and/or out-of-pocket cost of treatment!  Families may be eligible for up to $1,000 per year based on their needs!  Please complete the following information and we will contact you within the next 1-2 weeks to continue the process so you can access your funds.  Please email admin@ibt-inc.org with questions.
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Donated and brought to you by:
Child's Name (first and last) *
Child's Age *
Child's Date of Birth *
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Ethnicity *
Date of Initial Diagnosis *
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Date Services started *
(If "other", please state your situation)
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