Andrew’s Gift Program Grant Application

As part of our mission to support individuals and families living with autism, Andrew’s Gift is offering an opportunity for organizations in central Pennsylvania providing services to these individuals to receive financial support for the development of innovative programming and service delivery.  Organizations requesting funds must provide a clear plan detailing project priorities and implementation.  Recipients will also be required to report status of the project 6 months after receiving the items requested and a final report 12 months after receiving the items requested.

PART I 

 


PART II  

An asterisk ( * ) indicates a required field 

Organization Name *
Organization Name
Date Submitted
Date Submitted
County of services provided
Name of Contact *
Name of Contact
Address *
Address
Phone *
Phone
Fax
Fax
http://
$
Please be as specific as possible and provide detail information which will allow us to process the request more efficiently. Please note if you are requesting automobile, home improvements and camps, you will need to provide Andrew's gift two months prior to the requested start date and multiple estimates.
I certify that: *
I certify that: *
I certify that: *
I certify that: *
Checking the boxes below signifies agreement with the terms and conditions contained in Part I. *

As part of its application review process, Andrew’s Gift may request additional information from the applicant including financial information.