Email us info@newhampshiredsa.org

PO Box 259 Londonderry, NH 03053

Home
About
Resources
Support Grant
New Parents
Contact Us

Individual Grant Form

Requestor's Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email *

Participant's Name *

Participant's Date of Birth *

Relationship to Participant *

Within the last year, did you attend or volunteer at one of our events? Example: the Buddy Walk, Halloween Party, Winter Carnival etc.

Would you consider volunteering?

Name of program or budget request:

Description of program or budget request:

Explain the reasons for the funding request:

How does this program or budget request benefit the individual with Down syndrome?

Have you received any other funding for this program?

Total Cost *