CIDSO APPLICATION FORMS

Enrichment / Participation Funding Application

CONTACT INFORMATION
* Full Name
* Contact Address
* City
* State
* Zip Code
* Contact Email
* Contact Telephone
* Relationship to Individual with Down syndrome

If Other, please specify:

Person with Down syndrome for whom funding is requested
* Full Name
* Date of Birth
Full Address if different than above
Telephone if different than above
FUNDING INFORMATION
* Description of Product / Service for which Funding is Requested
Purpose of Product / Service - Benefit to Individual with Down syndrome
* List the Itemized cost(s) for the Funding Request
* Total Requested Cost
- Please enter only numbers and a decimal if needed, do not include the $ sign.
* Total Reimbursement Request (75%)

Upload Documents
Please upload documents to support the Cost Request.
- Please upload PDF or JPG files only.
- The file name(s) can not contain these characters: /\:*?"<>| or spaces.




Please email additional documents to cidsofamilies@gmail.com.
* Have you received full or partial reimbursement for the funds requested from any other source?
Yes    No
If yes, please list amount received and the source.
* Have you received CIDSO funding support for any reason?
Yes    No
If yes, please list the amount received and the purpose of that support.
* Please state the CIDSO committees and / or fundraisers on which the individual with Down syndrome and / or his / her family have actively participated and how in the past 24 months.


* Yes, I understand and agree to commit to CIDSO's funding requirements per the website.