Project Communicate IMPACT Autism
COMMUNICATION GRANT APPLICATION GENERAL INFORMATION:
The purpose of this project is to assist Alachua county families of children with autism spectrum disorders (ASD) with their efforts to increase their children's communication. Over the past year, IMPACT Autism has collected donations from local families, friends and businesses for this cause. IMPACT is offering an opportunity for families to apply for these funds. The funds can be used to purchase the services, training, or devices families might need to facilitate their child's communication. Each family can can request up to $500.

ELIGIBILITY:
Families living in Alachua County that have at least one child aged 3-21 years old diagnosed with ASD (i.e. autism, pervasive developmental disorder- not otherwise specified, fragile x, asperger's syndrome, rett's syndrome, or childhood disintegrative disorder) and a communication impairment can apply for funds.

DEADLINE TO APPLY:
Friday September 23, 2011 by midnight

APPLICATION GUIDELINES:
Complete the application form by clicking on the link below. You will need to describe in detail your child's communication needs and how the services, training, or devices you are requesting will be used. The following are just a few ideas of the types of resources you might request: (a) support for attending a conference, (b) customized visual supports (c) augmentative alternative communication devices, software or training (d) software or training (e) support to attending training workshops, or (f) professional communcation related assessments for your child

SELECTION PROCESS:
A review board of three members including two officers from IMPACT Autism and a staff member from UF-CARD will review each application. A limited number of families will be selected to receive a grant award, however, all families who apply will receive feedback from the review board, and assistance finding alternative solutions to support them in increasing their child's communication.


Please feel free to contact us by email at: impact.autism@gmail.com, if you have any questions.


To learn more about IMPACT Autism, please visit us at www.ImpactAutismUF.org

Parent / Family / Guardian Name *
Please provide the name of the person submitting this application
Your answer
Contact Information *
Please provide your contact information (phone or email) and list the days/times that you prefer to be contacted regarding this grant application
Your answer
Child's Name *
Please provide the name(s) of your child(ren) with autism spectrum disorders
Your answer
Child's Age *
Please provide the age(s) of your child(ren) with autism spectrum disorders
Your answer
Child's Communication Style *
How does your child express his/her wants, needs, thoughts or ideas? (Please select "Other" and specify if child uses Sign-Language or Picture Exchange Communication Systems).
Required
Communication Comprehension *
Please select the answer(s) you feel best represent your child's current communication comprehension level
Required
Reading Comprehension *
Please describe your child's literacy skills
Your answer
Child's School *
Please provide the name of the school that your child/ children attend
Your answer
Services Received at School *
Please list the types of services your child currently receives in school (e.g., assistance from an Aide, Therapy services such as Occupational Therapy, Physical Therapy, Speech Therapy, etc) and the frequency he/she receives them (i.e., how many days/week).
Your answer
Additional Services *
Please list any other services or resources your child currently receives outside of school (e.g., additional therapies, tutoring, respite care, after-school programs, etc.)
Your answer
Communication Challenges for your Child *
Please describe in your own words the biggest challenges your child experiences with communication. Feel free to provide examples and stories to illustrate your points.
Your answer
Current Communication Adaptations *
Please describe in your own words any methods you, your child, your family or others use to improve your child's ability to communicate.
Your answer
Proposed Solution and Resources Requested *
Please be sure to include the specific resources you are requesting, as well as their cost and exactly how they will be used to improve your child's ability to communicate.
Your answer
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