Neurodevelopmental Scholarship Application
To apply for this program please complete the application below.  Priority will be given to members who have been active with The FOUNDATION.  

In order to receive a scholarship, you must first contact Kay Ness and be on her schedule.
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First Name: *
Last Name: *
Address 1: *
Address 2:
City: *
State: *
Phone Number: *
Email: *
Child's First Name: *
Child's Last Name: *
Age: *
Has your child been evaluated by a Neurodevelopmentalist (ND)? *
If you are requesting a follow-up appointment, please provide the date of your last eval.
What are the areas you are most concerned about? *
If you have had a previous evaluation please answer the following questions.
 In what ways has the program benefitted your child?
What areas do you feel you need the most assistance with?
How many days per week on average are you able to work on any part of your program plan?  
Which specific activities do you find easiest to implement?
Do you have a therapist or tutor assisting you in implementing this program plan? *
Scholarship Amount
Please let us know the scholarship amount required.  Maximum amount for first visit is $325.  Follow up
appointments can request any amount necessary for your family to participate.  It is not guaranteed you
will receive the full amount requested.  It is our goal to allow as many families as possible to participate
so we will do our best to accommodate every need.  Please take into consideration if you can afford to
pay for a portion of your evaluation, that will allow another family the opportunity to participate.
Requested scholarship amount: *
First time families maximum scholarship amount is $325.  If you do not need a scholarship please enter $0.
Other Information
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This form was created inside of Down Syndrome Foundation Of Florida.