Autism Sensory Kit Grant Application

Name of Department (Do not list personal name)

Number of Kits requested

Number of vehicles in department

Contact Person

First

Last

Email

Phone

Address (list mailing address of the department)

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.