AIM2Help 2023

AIM2Help 2023

AIM2Help Grant Application
Applicant Name*

First NameLast Name
Applicant Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guradian*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of person completing application and relationship to applicant *

First NameMiddle NameRelationship to Applicant
List of items you are requesting, please list in order of preference. Pictures and website links are requested as they help us in purchasing the correct items. **AIM reserves the right to purchase an item(s) from an alternate site.***
YesNo
Upload Recommendation Letter*

Recommendation letter must be written from a professional who is part of the applicants current care team. Example: PCP, SLP, OT, PT, SpEd Teacher, Mainstream Teacher. Letters will not be accepted from a parent or a homeschool teacher.
Cancelof
If you have any additional supporting documentation please upload it here

Cancelof
Tell us how you have been involved with AIM in the past. Please list events you have attended, volunteer hours, ways you have contributed to the organization, etc. *
What type or events or programs would you like to see AIM offer in the future? How can we better serve your family or the community?
By submitting this application you are afreeing to the folloiwng, AIM requests permission to video and/or photograph you and/or your family during the time of the AIM2Help Grant pick up to be used in connection with our website, social media, newspaper, television, or radio presentations. These programs and presentations are the exclusive property of AIM and do not entitle any family member to compensation or remuneration for individual participation.
Should be Empty: