Autistic Children's Support Group of Worcester County

Funding Support Application

Please complete the application form below if you would like to apply for funding support.
Alternatively, you may email or write to us at Attn: Funding Request PO Box 1322 Ocean Pines, MD 21811

Application:

Child's Name:

Child's Address:

Parent/Guardian Name:

Diagnoses:

Phone: (optional)

Email:

Funding Request:

Briefly explain the reason the individual is in need of support funding:

Amount Requested:

What other resources have been attempted or exhausted?:

Requested By:

Name and Address for where the payment is to be sent:
(please email invoice if possible to acsgwc@gmail.com)

Please check I'm not a robot

The information provided on this website is for information purposes only, we do not advocate any treatment or any certain physician that may be listed or referenced in the material provided.

Seaside Sewing:

ACSG:
About Us
Events
Contact Us
Resources
Helpful Info
Donate

Visit us on Facebook