Autism Sensory Kit Grant Application

Name of Department

Number of Kits requested

Number of vehicles in department

Contact Person

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please Provide Department City and County

Terms and Conditions

I attest that I am applying for this grant as an official representative of the requesting department.

Terms and Conditions 2

Our department agrees to submit a photo with the sensory bag for publication to chenique@autism-alabama.org.

Terms and Conditions 3

Our department agrees to send a testimonial upon use of kit to chenique@autism-alabama.org.