IOMOTC Special Needs Assistance Fund (SNAF) Application
Application to assist families with multiple birth children meet the extraordinary expenses associated with raising a special needs, chronically ill or catastrophically injured child or immediate family member.
Email address *
Parent Name *
Your answer
Address *
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City *
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State *
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Zip Code *
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Telephone Number *
Your answer
Email Address *
Your answer
Name of Multiples Club
Your answer
Monetary Amount requested *
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Money will be used for: *
Required
Name of Person needing assistance *
Your answer
Please provide details of how the money will be used: *
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Reason why money is requested: *
Required
Medical Diagnosis for Recipient *
Your answer
Financial Services Currently Being Utilized *
Required
Employment Information *
Required
Please add any other information that you feel would help the committee understand your request for funds.
Your answer
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