Application date*
Name of Person with Down Syndrome*
DOB of person with Down Syndrome*
Does this person receive food stamps?* YesNo
Does this person receive free or reduced lunch?* YesNo
Did your family attend last year's Buddy Walk* YesNo
Did your family participate in any DSAB fund raising events? For example FirstGiving Page, garage sales, host any fundraising parties etc.* YesNo
Name of Parent(s) or legal guardian*
Address of Parent(s) or legal guardian*
Email of Parent(s) or legal guardian*
Phone of Parent(s) or legal guardian*
Name of entity that will receive DSAB funds*
Address of entity that will receive DSAB funds*
Phone Number of entity that will receive DSAB funds*
Brief description of services or activity. Please include date(s)*
Total amount required for service or activity (please provide documentation)* Amount family will pay towards cost* Amount of grant/scholarship/other offered by others for activity/service* Dollar amount of DSAB funds requested* Upload File