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 *
Address *
City *
State *
Zip Code *
Telephone Number *
Email Address *
Name of Multiples Club
Monetary Amount requested *
Money will be used for: *
Name of Person needing assistance *
Please provide details of how the money will be used: *
Reason why money is requested: *
Medical Diagnosis for Recipient *
Financial Services Currently Being Utilized *
Employment Information *
Please add any other information that you feel would help the committee understand your request for funds.
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