Family Grants Application Form

Please fill out all required fields and be sure to send in the required supporting documents. Applications cannot be considered until all required paperwork is received.

You can fill out the application below and submit it online or print it out (right mouse click>select print) and mail it to:

Asperger/Autism Network (AANE)
85 Main Street, Suite 3
Watertown, MA 02472

Please feel free to email the AANE Family Grants Administrator at grants@aane.org if you have any questions regarding the application process.

Family Information
By submitting this form, you are opting in to email communication from AANE. You may update your email preferences at any time by clicking the unsubscribe link at the bottom of AANE emails, excluding confirmation and reminder emails.
Contact information:
Your First Name*
Your Last Name*
Email*
Enter Email Confirm Email
Primary phone number*
Type of phone*
Hidden
What type of phone number is this:
- Mobile
- Landline
Your Location Information:
Street Address*
City*
State*
Hidden
State*
Postal Code*
Country*
Affiliation
Please indicate your relationship with an Autistic individual*
- Self
- Parent of adult
- Parent of teen
- Parent of child
- Grandparent
- Partner/spouse
- Ex-Partner/spouse
- Sibling
- Child (my parent has an Autistic individual)
- Other family member
- Friend
- Educator
- Other professional
- No relationship, interested in learning more
Please check all boxes that apply to you.
First name of Autistic individual*
Last name of Autistic individual*
Birthdate for Autistic individual*
MM slash DD slash YYYY
Grade in school for person with an Asperger/autism/neurodiverse profile(if applicable)
Eligible individual has the following diagnosis:*
Eligible individual lives more than half of their time in CT, MA, ME, NH, RI, or VT*
- Yes
- No
Request for Funds
Amount requested:*
What will you use the funds for?*
Please be specific.
Please enter any additional information or special circumstances that you wish to add to your request for a grant
What documentation of diagnosis will you be providing to AANE?*
- Neuropsychological or psycho-educational testing report
- Individualized Education Plan
- 504 Plan
- A signed letter stating that the individual has an autism spectrum diagnosis. The letter will need to be provided by a provider.
Documentation is required as part of this application
____________________________________________________________________________________
Family Financial Information
As soon as possible, you need to provide documentation of your total family income for the most recent year.
We cannot process incomplete applications (ones lacking documentation of diagnosis and of income). Please email all documentation to grants@aane.org
Enter the total of your family’s pre-tax income from all sources.*
Tax Return:*
- I am emailing a copy of page one of my most recent federal tax return, showing total family income (earned and unearned) before taxes.
- I am not required to file a tax return and do not file.
If you are not required to file a tax return, please select which of the following documentation you will provide:*
- Documentation of SSI payments received for yourself or your child's other parent/guardian
- Documentation of SSI payments received for your child
- Documentation of Transition Assistance payments received
Have you received family support funds this year from any other agency?*
- Yes
- No
____________________________________________________________________________________
Is this your first contact with AANE?*
- Yes
- No
How did you hear about us?*
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Family Grants Application Form

Family Information

Contact information:

Your Location Information:

Affiliation

Request for Funds

Family Financial Information