2020 Northern Colorado Down Syndrome Association Scholarship Form
Please do not print out this form-it is for online submission only. Please contact NCDSAscholarships@gmail.com for questions or to submit receipts or additional information.
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Email *
First and Last name of the individual requesting the scholarship: *
Name of the individual with Down Syndrome that will directly benefit from the scholarship: *
Date of the application: *
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Address, City, State and Zip Code *
Phone Number:
Category of funding requested (select one) *
Specific items or services requested *
Please explain how the individual with Down syndrome will specifically benefit from this request: *
Estimated cost/amount of items/services requested: *(Please remember that NCDSA DOES NOT PAY APPLICANTS DIRECTLY. IF THE SCHOLARSHIP APPLICATION IS APPROVED, THE NCDSA WILL EITHER REIMBURSE** THE APPLICANT OR FORWARD APPROVED FUNDS TO THE PROVIDER.) **Please email receipt to NCDSAscholarship@gmail.com if this is a reimbursement request. *
Date by which funds are needed: *
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Have you applied for a NCDSA scholarship this year? *
What is the anticipated out-of-pocket expense for this request? *
If approved, please list payment information: *Please include: NAME, ADDRESS, CITY, STATE, ZIP CODE *
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